San Luis Obispo — Petition for Restricted License

Source: https://www.slo.courts.ca.gov/documents/san-luis-obispo/Petition_for_Restricted_License_2.pdf

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

PEOPLE OF THE STATE OF CALIFORNIA v.

DEFENDANT: COURT CASE NUMBER: PETITION FOR RESTRICTED LICENSE (Vehicle Code, § 13202.5/13202.3)

I the undersigned, say that: 1. I am the defendant in the above-entitled action. 2. My date of birth is: 3. My Driver’s License number is: 4. I was convicted of on and consequently my driving privilege was suspended at the time for any other reason. 5. My driving privilege is not suspended at this time for any other reason. 6. Place an “X” in the applicable box(es):

I need my license to attend school. My principal/Dean has signed a statement (Part A) on page 2 that

school or transportation facilities are inadequate for regular attendance.

I need my license due to an illness of a family member. My physician has signed a statement (Part B)

on page 2.

I need my license for transportation to and from employment because the income from employment is

essential in the support of my family or an appreciable portion of my family income is derived from my

employment. My parent or guardian has signed a statement (Part C) on page 2.

7. Wherefore, I request the court to authorize a restricted license permitting me to do so.

I declare under penalty of perjury that the foregoing is true and correct.

DATED:

Signature: ______________________________________ Petitioner

ORDER

The foregoing petition is:

1. __ Denied. No critical need has been shown.

2. __ Granted. DMV to issue a license restricted as follows:

   __To and from work __ To an from school __ In the course of employment

   __Medical treatment

   __ Other: ______________________________________________________

Date:____ /_____ /_____ ________________________________________ (JUDICIAL OFFICER)

PETITION FOR RESTRICTED LICENSE Vehicle Code §§13202.5/13202.3

PART A

I declare that the person named in this petition is a student at _______________________________________
school and needs a restricted license to attend school and activities authorized by the school. I also declare that I
have verified that there is no public transportation within one mile of the student’s residence.

Dated: ______________ ________________________________________________________
Print/ Type your name

_________________________________________________________
Position/ Title

__________________________________________________________

Signature

PART B

I declare that I am a physician and that the operation of a vehicle by the minor petitioner is necessary due to
illness of a family member.

Name of family member: ________________________________________________________

Diagnosis: ________________________________________________________

Probable date of recovery: ________________________________________________________

Dated: ______________ ________________________________________________________
Print/ Type your name

__________________________________________________________
Signature

PART C

I declare that minor petitioner needs his license for transportation to and from employment and the income from
employment is essential for the support of the family, or an appreciable portion of the family income is derived
from the employment of the applicant.

Monthly Income: $____________________________________

Amount given to family: $____________________________________

I further declare that there is no public transportation within one mile of the petitioner’s residence.

Dated: ______________ ________________________________________________________
Print/ Type your name

__________________________________________________________
Signature

PETITION FOR RESTRICTED LICENSE
Vehicle Code §§13202.5/13202.3