1. Appeal form –
  2. On the Appeal print your name above “Appellant” in the caption at the top of the form. The docket number in the caption will be provided by the Prothonotary.
  3. Fill in all of the blank lines with the appropriate information.
  4. Your telephone number and address are required in case you need to be contacted by the Court or DOT. If your address or telephone information changes you must promptly notify the Court and DOT in writing.
  5. Place a check mark (☑) behind either “suspension” or “revocation”, whichever is appropriate.
  6. Attach a copy of the Official Notice of the suspension or revocation as Exhibit A.
  7. In paragraph 6 of the Appeal, you are requesting that the Court delay the effective date of the suspension until the appeal is resolved. If the stay is granted, you may continue to drive until further order from the Court or notice from DOT. However, if the suspension or revocation is based upon any of the following sections, a stay will not be granted by the Court immediately upon the filing of the appeal:
  8. Section 1503 (relating to persons ineligible for licensing; license issuance to minors; junior driver's license)
  9. Section 1504 (relating to classes of licenses)
  10. Section 1509 (relating to qualifications for school bus driver endorsements)
  11. Section 1514 (relating to expiration and renewal of driver's license)
  12. Section 1519 (relating to determination of incompetency)
  13. Section 1572 (relating to cancellation of driver's license)
  14. Section 1609.3 (relating to noncompliance with certification requirements)
  15. If the action of DOT is due to one of those sections and you wish for the court to delay the action DOT indicates it has taken in the notice you received, you must file a separate Motion requesting the Court to grant a supersedeas until final determination of the appeal by the Court and state the reasons why a supersedeas should be granted. The Court will decide whether and when to schedule a hearing on the motion.
  16. You must sign the Appeal at the end on the line provided. The term “pro se” means that you are representing yourself.
  17. Verification – The verification appears immediately after the signature line for the appeal. Sign and date the verification.
  18. Proposed Order – Submit the proposed order.