FAIRLIE & LIPPY, P.C. BY: Steven F. Fairlie, Esquire Attorney for Petitioner Attorney ID # 75936 Steve@fairlielaw.

net 1501 Lower State Road Building F, Suite 304 North Wales, PA 19454 (215) 997-1000 Fax (215)997-1777 IN THE COURT OF COMMON PLEAS OF BUCKS COUNTY PENNSYLVANIA CIVIL DIVISION
COMMONWEALTH OF PENNSYLVANIA : DEPARTMENT OF TRANSPORTATION : BUREA OF DRIVER LICENSING : :
v. : :

No.

MARK SKIERMONT

LICENSE SUSPENSION APPEAL

PRELIMINARY ORDER FOR HEARING AND NOW, this day of , 2010, upon

consideration of the foregoing Petition and on motion of , Steven F. Fairlie, Esquire, attorney for Petitioner, a hearing de novo is granted to determine whether the action of the Department of Transportation should be set aside. A Hearing is fixed for the at Pennsylvania. Petitioner to notify the Department forthwith. BY THE COURT: o'clock M. in Courtroom # day of , Bucks County Courthouse, Doylestown, , 2010,

______________________________ J.

LECKERMAN LAW, LLC BY: , ESQUIRE Attorney I.D. No. 101 Mechanics Street Doylestown, PA 18901 (800) 378-2110 IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA CRIMINAL DIVISION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION vs. : : NO. : : : : DL# *

ORDER AND NOW, this day of , 2008, upon

consideration of the foregoing Petition for Appeal from Order of Department of Transportation Suspending Driver's License, it is hereby ORDERED and DECREED that the Order of the Department be set aside. BY THE COURT:

________________________________ J.

LECKERMAN LAW, LLC BY: , ESQUIRE Attorney I.D. No. 101 Mechanics Street Doylestown, PA 18901 (800) 378-2110 IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA CRIMINAL DIVISION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION vs. : : NO. : : : : DL# *

PETITION FOR APPEAL FROM ORDER OF DEPARTMENT OF TRANSPORTATION SUSPENDING DRIVER'S LICENSE TO THE HONORABLE, THE JUDGES OF SAID COURT: The Petition of respectfully represents: 1. 2. 3. That resides at . That currently possesses a valid driver's license. That on *April 4, 2006, was notified by the Department of Transportation that

driver's license would be suspended for the following reason as set forth in the notice, a copy of which is attached hereto and is marked as Exhibit "A". 4. That the said suspension is improper for the following reasons: a. Petitioner submits did not knowingly, intelligently and voluntarily refuse

to submit to a chemical test. b. or arrest. WHEREFORE, your Petitioner thereby prays that this matter be set down for the hearing The Petitioner submits no reasonable grounds existed for the stop, seizure

de novo before your Honorable Court as provided by the Vehicle Code and the Order of the Department be set aside. Respectfully Submitted, By: Date: _________________________ , ESQUIRE

VERIFICATION I, , ESQUIRE, verify that the statements made in the foregoing are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 48 Pa. C.S. Section 4904, relating to unsworn falsification to authorities.

_____________________________ , ESQUIRE Date: