___
Appellant
No. ___ -S-___
V.
AND NOW, this ___ day of___, 20___, in consideration of the Appeal From License Suspension/Appeal filed on ___, 20___, a hearing will be held on ___, 20___, at ___: ___.m. in Courtroom No. ___, _____ Floor, Adams County Courthouse, 117 Baltimore Street, Gettysburg, Pennsylvania.
I he action of the Department of Transportation in suspending/revoking the Appellant's driving privileges is/is not stayed and shall/shall not act as a supersedeas pending further Order of Court.
Appellant is directed forthwith to serve a copy of this Order on the Pennsylvania Department of Transportation, Office of Chief Counsel, 1101 South Front Street, Third Floor, Riverfront Office Center, Harrisburg, PA 17104-2516 by certified mail, return receipt requested. Appellant shall file a Certificate of Service of the Order with the Prothonotary upon completion of service.
BY THE COURT,
___
Judge