GARFIELD HEIGHTS MUNICIPAL COURT

Cuyahoga County, Ohio

Application for Limited Driving Privileges

Full Name____________________________________________________________________________

Residence Address______________________________________________________________________

(Area Code) and Phone Number (___________) ______________________________________________

S.S.N.________________________________________________________________________________

Type of Suspension_____________________________________________________________________

Complete the following for each type of privilege requested.

1. Employment:

Employer’s Name and Telephone Number_______________________________________

Employer’s Address_________________________________________________________

Days and hours of work______________________________________________________

2. Education:

School Name and Telephone Number___________________________________________

School’s Address___________________________________________________________

Days and hours of school_____________________________________________________

3. Medical Treatment:

Provider Name and Telephone Number_________________________________________

Provider’s Address_________________________________________________________

Reason for Treatment_______________________________________________________

The following documents must be attached to this application or the application will be denied.

1. Proof of insurance/financial responsibility for period of suspension or 6 months, whichever is less
2. Proof of payment for insurance/financial responsibility for period of suspension or 6 months, whichever is less
3. Letter from employer verifying days and hours of work.

Application must be accompanied by court costs payment found
in the schedule of costs on this website.

Checks to be made payable to the Garfield Heights Municipal Court.