IN THE CIRCUIT COURT OF THE _________________ (Number) JUDICIAL CIRCUIT
IN AND FOR ____________________ (Name) COUNTY, FLORIDA
APPELLATE DIVISION
CASE NO. ______ __ __ AP
___________________________ Petitioner
(Name of Petitioner)
v.
STATE OF FLORIDA, DEPARTMENT
OF HIGHWAY SAFETY AND
MOTOR VEHICLES, Respondent
PETITION FOR WRIT OF CERTIORARI
Petitioner, ______________________ (Name of Petitioner) , pursuant to Fla. R. App. P.
9.100, '322.2615, Fla. Stat. and 322.31, Fla. Stat., respectfully petitions this Honorable Court to
iss ue a Writ of Certiorari to review the final order rendered on ___________________ (date) , by
the Department of Highway Safety and Motor Vehicles/Bureau of Administrative Review
sustaining the administ rative suspension of Petitioner’ s driver license under 322.2615, Fla. Stat.
A. at 37 -38.1 .
I.
JURISDICTION
This Court has jurisdiction to issue a wr it of certiorari under Fla. R. App. P. 9.030(c)(2001);
Fla. Stat. ' 322.31(2000). Art. V, 5(b), Fla. Const. (1980). Section 3 22.2615(13), Fla. Stat.,
provides that review of orders sustaining administrative suspensions imposed pursuant to that
statute shall be obtained by means of a “ petition for writ of certiorari to the cir cuit court pursuant
to '322.31.” The Driver resides in _____________________ (Name) County and the issuance of
the Notice of Suspension was in _____________________ (Name) County, Florida. Since
Petitioner has a statutory right to file this petition in the county where he resides, this Court has
subject matter and personal jurisdiction over this case. '322.2615(13), Fla. Stat.
II.
STATEMENT OF THE FACTS
(Fill in applicable facts) .
____________________________________________________________________________
___________________________ _________________________________________________
____________________________________________________________________________
____________________________________________________________________________
III.
NATURE OF RELIEF SOUGHT
The Petitioner seeks an Order of this Court granting his Petition for Writ of Certiorari,
quashing the Department of Highway Safety and Motor Vehicles Order upholding the
suspension of his driver’s license and ordering that the Petitioner’s driving privileges be
reinstated.
IV.
ARGUMENT
(State Legal Argument) .
____________________________________________________________________________
____________________________________________________________________________
______________________________________________________________________ ______
V.
CONLCUSION
Based on the foregoing, the Hearing Office departed from the essential requirements of
law and due process which requires that the suspension be set aside and vacated and the
reinstatement of Petitioner’s driving privileges.
WHEREFORE, the licensee respectfully requests that the suspension be set aside and
that his full driving privileges be immediately restored and for such other further relief as this
Honorable Court deems just and proper.
Respectfully submitted,
________ _______________
Name of Petitioner
________________________________
________________________________
Address of Petitioner
________________________________
Phone Number of Petitioner
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing was sent by
hand/U.S. Mail to the Office of the General Counsel to the Department of Highway Safety
and Motor Vehicles, Office of the General Counsel , (for example: 2515 West Flagler, Miami,
Florida, 33135 and Florida Department of Financial Services, Division of Risk
Management, Bureau of State Liability Claims, 200 E. Gaines Street, Tallahassee, FL
32399 -0338) _________________________________________________________________
___________________________________ _________________________________________
__________________________________ , this __ ___ day of _________________, 20______ .
Respectfully submitted,
____________ ___________
Name of Petitioner
___________________________
___________________________
Address of Petitioner
___________________________
Phone Number of Petitioner
CERTIFICATE OF SERVICE
I DO HEREBY CERTIFY that a true and correct copy of the foregoing has been
furnished by U. S. Mail to the Department of Highway Safety and Motor Vehicles, to Hearing
Officer ____________________ (Name) at _________________________________________
_________ _________________________ (street address, city, county, state, zip code) this
____________________ (date) .
Respectfully submitted,
_______________________
Name of Petitioner
___________________________
___________________________
Address of Pet itioner
___________________________
Phone Number of Petitioner
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