Fill and Sign the Mississippi Hardship Form

IN THE CIRCUIT COURT OF       COUNTY, MISSISSIPPI       , PETITIONER VS. NO.       MISSISSIPPI DEPARTMENT OF PUBLIC SAFETY, RESPONDENT ORDER THIS DAY this cause came on to be heard on the Petition of       , Petitioner herein, for a reduction of the suspension period of his/her driver's license under Section 63 - 11 - 30 (2)(a), Miss. Code Ann, (1972) as Amended, (Implied Consent Law) and the Court having heard and considered all of same, and being of the opinion that it has complete jurisdiction, finds as follows, to - wit: 1. The Petitioner is a first offender under the Implied Consent Law, being Section 63 - 11 - 30 (2)(a), Miss. Code Ann, (1972) as Amended, and his/her driving privileges have been under suspension for a period of thirty (30) days under Section 63 - 11 - 30 (2)(a). 2. The Petitioner's Mississippi driver's license number is       . 3. The Petitioner's address is       ,       , Mississippi, date of birth is       , color of hair is       , eyes are       , weight is       pounds, height is       , social security no. is       . 4. The Petitioner's specific grounds upon which the hardship is determined are that Petitioner's employment may be terminated if he/she is not allowed to possess a valid Mississippi driver's license.       incorporated therein by reference. IT IS, THEREFORE, ORDERED AND ADJUDGED, that the suspension period of the driver's license of       , issued by the State of Mississippi, be reduced to thirty (30) days and that       , Petitioner, is hereby granted a Temporary Order which will allow the Petitioner to operate a motor vehicle for a period of not more than ninety (90) days from the date of this Order and further, that the Clerk of the Court shall within (5) days of entry of this Order deliver to the Commissioner of Public Safety a certified copy of this Order. Such Temporary Order shall automatically become a permanent Order after thirty (30) days if the Commissioner of Public Safety or the attorney designated to represent the state does not object in writing to the Court. IT IS, FURTHER, ORDERED AND ADJUDGED that full reinstatement of driving privileges is dependent upon the Petitioner meeting the following requirements: 1. The Petitioner has been under suspension for a minimum of thirty (30) days as required by law in a hardship case pursuant to Section 63 - 11 - 30 (2)(a) Miss. Code Ann, (1972), as Amended. 2. That the Petitioner pays unto the Department of Public Safety/Mississippi Highway Safety Patrol a One Hundred Dollar ($100.00) reinstatement fee as required by Section 63 - 1 - 46. Miss. Code Ann, (1972), as Amended. 3. That the Petitioner has filed with the Department of Public Safety/Mississippi Highway Safety Patrol proof of financial responsibility (SR - 22) as required by Section 63 - 15 - 35, Mississippi Code of 1972, Annotated; and 4. That the Petitioner's driving privileges are not presently suspended or revoked under anv other statute or for any other reason not related to this cause of action. SO ORDERED this the       day of       , 20       . ________________________________________ CIRCUIT COURT JUDGE Prepared and presented by:                         Telephone:       MSB #       Attorney for