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State of Minnesota

County Judicial District: Court File Number: Case Type:

District Court
Other Civil

___Blake Edmund Christian__, Petitioner vs.

Petition for Hearing on Reinstatement of Drivers License Minn. Stat. 171.19

Commissioner of Public Safety, Respondent Petitioner petitions this Court for reinstatement of his/her driving privileges pursuant to Minn. Stat. 171.19 and states as follows: 1. 2. My name is Blake Edmund Christian and I currently live at 251 Halsey Avenue NE, Wright (County).

Buffalo, Minnesota (address) in _

On or about ___July 22,2010_ (date), I received notice from the Department of Public Safety, Driver and Vehicle Services Division, that stated my drivers license will be or was (check the box that applies) refused suspended X revoked cancelled disqualified, effective August 1st, 2010 (date), for a period of ___1 year.__(days/year).

3.

The notice states that my license was taken because Alcohol Concentration was .20 or more. and that the incident occurred in (name of city) St. Michael, MN

4.

My license was not revoked or disqualified under Minn. Stat. 169A.52 for failing or refusing a chemical test to determine intoxication, and was not suspended for non-payment of support under Minn. Stat. 171.186.

5.

For the license problem described at #2 and #3: X This is the first time I have filed a court Petition for reinstatement of my driving license OR

CIV111

State

ENG

Rev 4/10

www.mncourts.gov/forms

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I previously filed a Petition and the court denied my request to get my drivers license reinstated. The hearing date was (mo/day/yr)______________and today is at least 1 year since the hearing date. (If it is less than one year, you cannot file now.) 6. 7. 8. My date of birth is February 21, 1992. My drivers license number is W933260550615____________________________. I believe that my license should be reinstated because

9.

X I am filing this petition within 180 days of the effective date of the order of revocation, suspension, cancellation, disqualification or refusal notice. I am filing this petition before the expiration date of the revocation, suspension, cancellation, disqualification or refusal.

Wherefore, petitioner seeks judgment of this Court as follows: 1. Reinstatement of petitioners driving privileges pursuant to Minn. Stat. 171.19. 2. For such other and further relief as the Court deems just and proper.
Dated: Signature of Petitioner, pro se (Sign only in front of notary public or court administrator.) Name: Sworn/affirmed before me this day of , Address City/State/Zip: Blake Edmund Christian 251 Halsey Avenue NE., Buffalo, MN 55313

Telephone: ( 763 ) 477-4334 Notary Public \ Deputy Court Administrator

CIV111

State

ENG

Rev 4/10

www.mncourts.gov/forms

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