OPERATOR'S PETITION FOR COURTREVIEW OF RMV LICENSE SUSPENSIONFOR CHEMICAL TEST REFUSALCIVIL DOCKET NO. (court use only)Trial Court of Massachusetts District Court Department This petition for review may be filed in the appropriate District Court division only after the operator has appeared at the RMV for a licensesuspension hearing and the RMV has issued a decision. It must be filed within 30 days after issuance of the Registrar’s final determination (G.L.c.90,§24[1][g]), along with a filing fee of $195 (G.L. c.262,§§ 2, 4C) unless waived for indigency (G.L. c.261,§§ 27A-29).  The statute requires thatthe Court’s review be limited to“the record established at the hearing before the registrar”(§24[1][g]) and therefore the operator may not introduceadditional evidence before the Court.Pursuant to G.L. c. 90,§24(1)(g), I request court review of the decision of the Registrar of Motor Vehicles upholding the suspensionof my license, permit or right to operate a motor vehicle under G.L. c. 90,§ 24(1)(f)(1) based on my alleged refusal to submit to achemical test or analysis of my breath or blood at the time of my arrest for operating a motor vehicle while under the influence ofintoxicating liquor. This proceeding is civil in nature and is not part of the underlying criminal OUI case. Please review that the petitioner has provided all theinformation required above and then complete this portion of this form.  Fax a photocopy of this form immediately to the Registry of MotorVehicles Suspension Department at (857) 368-0019. By way of appearance and answer, the RMV will forward copies of the RMV hearing recordto the court and to the operator within 15 days. A judge must then review this petition“as soon as possible”and no later than 30 days after thepetition is filed (G.L. c.90§24[1][g]). RMV questions may be directed to (857) 368-8207 FOR COURT CLERK'S USE ONLYOPERATOR'S NAMEDATE OF BIRTHLICENSE NO.STATE ISSUING LICENSEDATE OF ARRESTPOLICE DEPT.DATE OF RMV HEARINGDATE OF RMV DECISIONDATESIGNATURE OF OPERATORXDATE & TIME OF SCHEDULED COURT REVIEW (within 30 days from filing of petition)COURT NAME & ADDRESSCOURT EMPLOYEE'S NAMECLERK'S OFFICE FAX NO.DATE FAXED TO RMV  (keep FAX confirmation in file)COURT EMPLOYEE'S PHONE NO. & EXTENSIONDATEJUDGE'S SIGNATUREJUDGE'S PRINTED NAMEDECISION OF THE COURT (To be completed by Judge after court review) This Court’s review is limited to“the record established at the hearing before the registrar”(G.L. c.90,§24[1][g]). The Registrar hasrelied on the submission of that hearing record, including the hearing officer’s decision, for its appearance and answer in this matter.After review of that hearing record, I find as follows:The Registry exceeded its constitutional or statutory authority.   (If yes, see specific findings below.)The Registry made an erroneous interpretation of the law.  (If yes, see specific findings below.)The Registry acted in an arbitrary and capricious manner.  (If yes, see specific findings below.)The Registry made a determination which is unsupported by the evidence in the record.  (If yes, see specificfindings below.)YESNOSPECIFIC FINDINGS:Accordingly, it is ORDERED that judgment shall enter:AFFIRMINGREVERSINGthe Registrar's determination:DISMISSING the petition for review because it was not timely filed.DISMISSING the petition for review because the petitioner failed to appear,the Registry’s hearing record serving as its appearance and answer.CLERK-MAGISTRATE: Please FAX the result of the judicial review to the RMV immediately at (857) 368-0019Xhttp://www.mass.gov/courts/courtsandjudges/courts/districtcourt/forms.html(07/2012)