
IN THE MUNICIPAL COURT OF DELAWARE COUNTY, OHIO
70 North Union Street • Delaware, Ohio 43015 • 740.203.1570 • Fax 740.203.1599 • www.municipalcourt.org
Case #
_____________________________
Defendant
Choose only ONE:
If neither is checked – ruling will be mailed
Will pick up
Please mail
Motion for Limited Driving Privileges
ALL INFORMATION SUBJECT TO VERIFICATION
Defendant moves the court to grant limited driving privileges as shown and certifies that the following is true and accurate:
1. Applicant’s Current Residence Address
(MUST BE COMPLETE
)
________________________________________________________________
Street City/State/Zip
License #____________________
Employer/School Information
ALL INFORMATION MUST BE COMPLETED
__________________________
___________________________
__________________________
___________________________
__________________________
___________________________
F. Normal days and hours – EXCLUDING
commute time: (if hours are omitted your
application may be denied. Excessive hours (i.e.
50 hrs/week or more or more than 10 hrs/day)
WILL cause delay/denial and/or lead to added
restrictions
Check ONLY if you are “on call” during
other hours. Explain below on line 5.
________________________________________________________________
6. Certain OVI offenders are limited to driving vehicles with restricted plates. Vehicle owners MUST submit OBMV
Form 4808 for EACH vehicle to obtain plates.
The undersigned certifies the information herein is true
X_____________________________________________
Defendant’s signature (not required if filed by attorney)
Signature & REG # of Atty X________________________________
Phone X
PRINT name of Atty X________________________________
(IF filed by attorney)
Motion for Limited Driving Privileges During ALS/Court Suspension
Municipal Court 10/21/2011