1. Appellant respectfully suggests that DOT's proposed suspension (___) revocation (___) is unlawful or improper because ___
  2. Appellant requests that this Appeal act as a supersedeas and stay the imposition of the suspension (\_\_) revocation (\_\_) pending further order of this Court.

WHEREFORE, Appellant respectfully requests this Honorable Court schedule a hearing on this appeal, grant a supersedeas and, after hearing, sustain this appeal.

Respectfully submitted,

Appellant, pro se

I verify that the statements made in this Appeal are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. §4904, relating to unsworn falsification to authorities.

Date

Appellant