Free State of Minnesota - Minnesota

State of Minnesota
County
Select County

District Court
Judicial District: Court File Number: Case Type: Civil

Petition for Review of Administrative Impoundment Order (License Plates) (Minn. Stat. §169A.60, subd. 10) Petition for Approval of Issuance of Special Plates After Judicial Impoundment Order (Minn. Stat. §168.041, subd. 6) Petition for Approval of Transfer of Vehicle After Judicial Impoundment Order (Minn. Stat. §168.041, subd. 7)

___________________________________________

vs.

Petitioner

Commissioner of Public Safety Respondent

, petitioner states that my current address is . My date of birth is My driver's license number is: My license plate number is: The date of the violation is: The violation is: The name of the violator is: _____________________________________ The law enforcement agency that issued the plate impoundment order is: ____________________________________________________________ An impoundment order was issued on by Judge County District Court or by the Commissioner of Public Safety.

in

FOR602

State

ENG

Rev 8/05

www.courts.state.mn.us/forms

Page 1 of 3

I request that the Court allow the impounded plates in the above entitled matter to be returned to Petitioner according to Minn. Stat. §169A.60, subd. 10. I request that the Court allow the Commissioner of Public Safety to issue special plates according to Minn. Stat. §168.041, subd. 6. I request that the Court allow transfer of title to the vehicle subject to the judicial impoundment order according to Minn. Stat. §168.041, subd. 7. I request this for the following reasons: 1.

2.

3.

Dated:
Signature (Sign only in front of notary public or court administrator.)

Name: Sworn/affirmed before me this day of , . Address: City/State/Zip: Telephone:
Notary Public \ Deputy Court Administrator

FOR602

State

ENG

Rev 8/05

www.courts.state.mn.us/forms

Page 2 of 3

State of Minnesota
County
Select County

District Court
Judicial District: Court File Number: Case Type: Civil

ORDER

___________________________________________

vs.

Petitioner

Commissioner of Public Safety Respondent

Judge

The hearing was held/the matter was considered on in

by County District Court.

After considering the file and records, It Is Ordered: The impoundment order is: Stayed for the balance of impoundment period (impounded plates are returned) Rescinded (impounded plates are returned) Sustained (impounded plates continue to be impounded) The Commissioner of Public Safety shall issue special plates to the following: (petitioner's name, address, plate #)

The Court does/does not certify consent for transfer of title for the registered owner's motor vehicle. Dated: Judge of District Court
Distribution ___ Copy for Plaintiff

___ Copy for Prosecutor

___ Copy for Commissioner

FOR602

State

ENG

Rev 8/05

www.courts.state.mn.us/forms

Page 3 of 3