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            "text": "IN THE COURT OF COMMON PLEAS OF ADAMS COUNTY, PENNSYLVANIA\nCIVIL ACTION - LAW",
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            "text": "Appellant"
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            "text": "No. ___ -SU-___"
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            "text": "V."
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            "text": "COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF TRANSPORTATION, BUREAU OF DRIVER LICENSING Appellee",
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            "text": "APPEAL FROM SUSPENSION/REVOCATION OF OPERATING PRIVILEGES",
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            "text": "AND NOW, this ___ day of___, 20___, comes the Appellant,\n___, who respectfully avers as follows:"
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            "text": "Adams County, Pennsylvania, 17_____and the telephone number at which he/she can be contacted during normal daytime business hours is (_____) - _____ - _____."
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                    "text": "Appellant's Pennsylvania Driver License Number is listed on the Confidential Information Form included with this filing.",
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                    "text": "Appelle is Commonwealth of Pennsylvania, Department of Transportation, Bureau of Driver Licensing, hereinafter DOT.",
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                    "text": "Appellant has received notice dated ___ that his/her operating privileges has been suspended (___) revoked (___) by DOT effective ___ for a period of ___ days/months/years (circle one) pursuant to Section ___ of the Pennsylvania Vehicle Code. A copy of said notice is attached hereto and marked as Exhibit \"A\".",
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