Here is the text we could read:
STATE OF MICHIGAN
JUDICIAL CIRCUIT
COUNTY
ORDER REGARDING
DRIVER’S LICENSE RESTORATION
(Part 1)
CASE NO. and JUDGE
Court address
Court telephone no.
Date of hearing:
Judge
1. On
Date
petitioner filed a petition for review of the
Date
a. (For arrests on or after 10/1/99.)
application denial for medical reasons (MCL 257.303[1][d]).
driver assessment suspension, restriction (not a revocation) (MCL 257.310d, MCL 257.320).
first implied consent suspension (MCL 257.323[3] and MCL 257.625f).
mandatory additional suspension for driving while license suspended (not a revocation) (MCL 257.904[10] or
second implied consent suspension (MCL 257.323[4] and MCL 257.625f).
[11]).
b. (For arrests from 1/1/92 through 9/30/99.)
licensing action
.
IT IS ORDERED:
2. The Secretary of State shall restore a driver’s license with full privileges to the petitioner.
3. The Secretary of State shall issue restricted driving privileges as follows.
a. The petitioner may drive to and from the residence and place of employment and in the course of employment, to
a substance abuse treatment program and/or support group meetings, to regularly scheduled treatment for a
serious medical condition, to the probation office and community service, and to an educational institution. The
petitioner must carry proof of destination and hours.
b. If there is any evidence of drinking while using a motor vehicle, or if there is a violation of this order during the period
that this order is in effect, police shall confiscate the driver’s license and return it to the court. A hearing will be held
if requested by the petitioner within 14 days from the date the license is confiscated.
Petitioner’s name, address, and telephone no.vRespondentSECRETARY OF STATEOF THE STATE OF MICHIGANDriver Assessment and Appeal DivisionPO Box 30196Lansing, Michigan 48909-7696Driver’s license no. Date of birthPetitioner’s attorney, bar no., address, and telephone no.Respondent’s attorney, bar no., address, and telephone no.Approved, SCAOForm CC 268, Rev. 5/21MCL 257.323, MCL 257.323a-cPage 1 of 2Distribute form to: Court (Part 2)Secretary of State (Part 1)Petitioner (Part 1)Attorney General/Prosecutor (Part 1) Order Regarding Driver’s License Restoration
Page 2 of 2
(5/21)
Case No.
3. (continued)
c. Provided the petitioner abides by the conditions of this order, the restricted driver’s license shall terminate on
AND
on that date the petitioner shall appear before the court for further examination and review. OR
the court relinquishes jurisdiction to the Secretary of State. OR
on that date the Secretary of State shall restore full driving privileges.
4. The petitioner’s appeal for licensing privileges is denied.
5. Any relief granted in this order is effective only for an action listed in item 1 above.
6. This order shall be void and without effect if a certified copy of this order is not served on the Secretary of State, Driver
Assessment and Appeal Division, PO Box 30196, Lansing, Michigan 48909-7696 within 7 days of the date this order is
signed.
Approved as to form:
Assistant attorney general/Assistant prosecuting attorney
Judge signature and date
CERTIFICATE OF MAILING
I served a certified copy of this order on the Secretary of State by first-class mail at the address provided in this order as
defined by MCR 2.107(C)(3). I declare under the penalties of perjury that this certificate of mailing has been examined by
me and that its contents are true to the best of my information, knowledge, and belief.
Date
Signature of petitioner
STATE OF MICHIGAN
JUDICIAL CIRCUIT
COUNTY
ORDER REGARDING
DRIVER’S LICENSE RESTORATION
(Part 2)
CASE NO. and JUDGE
Court address
Court telephone no.
Date of hearing:
Judge
1. On
Date
petitioner filed a petition for review of the
Date
a. (For arrests on or after 10/1/99.)
application denial for medical reasons (MCL 257.303[1][d]).
driver assessment suspension, restriction (not a revocation) (MCL 257.310d, MCL 257.320).
first implied consent suspension (MCL 257.323[3] and MCL 257.625f).
mandatory additional suspension for driving while license suspended (not a revocation) (MCL 257.904[10] or
second implied consent suspension (MCL 257.323[4] and MCL 257.625f).
[11]).
b. (For arrests from 1/1/92 through 9/30/99.)
licensing action
.
IT IS ORDERED:
2. The Secretary of State shall restore a driver’s license with full privileges to the petitioner.
3. The Secretary of State shall issue restricted driving privileges as follows.
a. The petitioner may drive to and from the residence and place of employment and in the course of employment, to
a substance abuse treatment program and/or support group meetings, to regularly scheduled treatment for a
serious medical condition, to the probation office and community service, and to an educational institution. The
petitioner must carry proof of destination and hours.
b. If there is any evidence of drinking while using a motor vehicle, or if there is a violation of this order during the period
that this order is in effect, police shall confiscate the driver’s license and return it to the court. A hearing will be held
if requested by the petitioner within 14 days from the date the license is confiscated.
Petitioner’s name, address, and telephone no.vRespondentSECRETARY OF STATEOF THE STATE OF MICHIGANDriver Assessment and Appeal DivisionPO Box 30196Lansing, Michigan 48909-7696Driver’s license no. Date of birthPetitioner’s attorney, bar no., address, and telephone no.Respondent’s attorney, bar no., address, and telephone no.Approved, SCAOForm CC 268, Rev. 5/21MCL 257.323, MCL 257.323a-cPage 1 of 2Distribute form to: Court (Part 2)Secretary of State (Part 1)Petitioner (Part 1)Attorney General/Prosecutor (Part 1) Order Regarding Driver’s License Restoration
Page 2 of 2
(5/21)
Case No.
3. (continued)
c. Provided the petitioner abides by the conditions of this order, the restricted driver’s license shall terminate on
AND
on that date the petitioner shall appear before the court for further examination and review. OR
the court relinquishes jurisdiction to the Secretary of State. OR
on that date the Secretary of State shall restore full driving privileges.
4. The petitioner’s appeal for licensing privileges is denied.
5. Any relief granted in this order is effective only for an action listed in item 1 above.
6. This order shall be void and without effect if a certified copy of this order is not served on the Secretary of State, Driver
Assessment and Appeal Division, PO Box 30196, Lansing, Michigan 48909-7696 within 7 days of the date this order is
signed.
Approved as to form:
Judge signature and date
Assistant attorney general/Assistant prosecuting attorney
CERTIFICATE OF MAILING
I served a certified copy of this order on the Secretary of State by first-class mail at the address provided in this order as
defined by MCR 2.107(C)(3). I declare under the penalties of perjury that this certificate of mailing has been examined by
me and that its contents are true to the best of my information, knowledge, and belief.
Date
Signature of petitioner
