76

2249
Identification Numbers
06EEP80221
V3713771961
State of New Hampshire
Department of Safety
Division of Motor Vehicles
23 Hazen Drive, Concord, N.H. 03305
JOHNJ.BARTHELMES
Commissioner of Safety
RICHARD C. BAILEY JR.
Director of Motor Vehicles
KEENE DISTRICT COURT Date: 11/21/2013
3 WASHINGTON ST., P.O. BX 364
KEENE, NH 03431
1-855-212-1234
NOTICE OF ACTION BY THE DIRECTOR
PETER M EYRE

KEENE NH 03431-
File Number:
-+
AT 12:01 A.M.
Date of Birth: 0 6 / 2 2 / 8 0
AS A RESULT OF: FAILURE TO PAY COURT FINE
KEENE DISTRICT
WARNING - THIS NOTICE DOES NOT REPLACE ANY PRIOR NOTICE ALREADY IN EFFECT.
FOR THE REASONS SHOWN ABOVE YOU ARE HEREBY NOTIFIED OF THE FOLLOWING ACTION IN ACCORDANCE WITH THE
STATUTORY PROVISIONS OF THE MOTOR VEHICLE LAWS, EFFECTIVE ON THE DATE SHOWN TO THE RIGHT OF THE ARROW ABOVE.
YOUR LICENSE/OPERATING PRIVILEGE IS SUSPENDED INDEFINITELY.
YOU MAY BE CONSIDERED FOR RESTORATION IF
YOU COMPLETE THE FOLLOWING REQUIREMENTCSJ:
DEFAULT TO BE CLEARED
BE SURE TO READ THE BACK OF THIS FORM
NEW HAMPSHIRE DEFAULT INSTRUCTIONS:
If you have defaulted a summons, failed to pay a fine or defaulted an administrative fee you must:
A) Clear the problem with the court or the department listed in the upper left hand corner of this form (see instructions on back) .
B) If the name of a court appears above in the upper left hand corner then you have defaulted that court and the COURT ISSUED RECEIPT must be received
by the Division of Motor Vehicles PRIOR to tli S..effective suspension date. WARNING: .This receipt is the ONLY proof this agency can accept, or,
C) If the name of this agency appears above in the uRPer left hand corner then you have defaulted this department and the matter must be settled here PRIOR.
to the suspension effective date. . .\
D) Once the suspension has gone into effect, you will be assessed a reinstatement fee (see below) by the Division of Motor Vehicles. The default has to be cleared and the
reinstatement fee paid BEFORE your privileges can be restored. MAKE CHECKS PAYABLE TO "STATE OF NH MV" FOR PAYMENT OF All
_REINSTATEMENLEEES. ___ _
OUT-OF-STATE COURT DEFAULT INSTRUCTIONS:
If you have failed to pay a fine or defaulted a court summons to the out-of-state court listed above:
A) You must clear the problem with the out-of-state court and obtain a reinstatement from the out-of-state Department of Motor Vehicles.
B) The COURT ISSUED RECEIPT with proper "Identification Numbers" (located in the upper left-hand corner above) and the notification of reinstatement from the out-of-state
Department of Motor Vehicles must be presented to the Division of Motor Vehicles PRIOR to the effective suspension date.
C) If the suspension goes into effect you must cease driving, and not drive again until you have written confirmation that your license has been reinstated by the New Hampshire
Division of Motor Vehicles.
D) 15 days after the suspension has gone into effect, a Reinstatement Fee (see below) will also be assessed. This Reinstatement Fee is in ADDITION to any other fees and fines
assessed by the court. These fees and the COURT ISSUED RECEIPT have to be on file at the Division of Motor Vehicles before your license and/or operating privileges
can be restored. MAKE CHECKS PAYABLE TO "STATE OF NH -- MV" FOR PAYMENT OF All REINSTATEMENT FEES.
CAUTION CAUTION CAUTION
Once this order becomes effective, you MUST IMMEDIATELY SURRENDER YOUR NEW HAMPSHIRE LICENSE to the DIRECTOR.
You are NOT TO DRIVE until you have WRITTEN CONFIRMATION that your license and/or operating privileges have been reinstated.
Restoration can not be accomplished if you are under SUSPENSION OR REVOCATION for other reasons. Any correspondence
or remittance should include your FULL NAME and DATE OF BIRTH.
IF NO FINE AMOUNT APPEARS ABOVE, YOU MUST CONTACT THE COURT IN PERSON.
FEES: Reinstatement-
G254 (DSMV 254 - rev 05/1 0)
Refer phone inquiries: 603-271-3101
Speech/Hearing Impaired Relay TTYITDD 1-800-735-2964

Richard C. Bailey Jr., Director
Division of Motor Vehicles
WARNING WARNING WARNING
New Hampshire has a serious habitual offender law. You may or may not qualify as a habitual offender. You may or may not
be close to qualifying BUT in a sincere effort to tell you about the habitual offender law, the Division of Motor Vehicles is
utilizing this notice in the hope you will read and heed its warning.
The purpose of the habitual offender law is to provide maximum safety for all persons who travel in New Hampshire, discourage
repeated patterns of conviction and DENY license and operating privileges to individuals who fail to repect and obey our laws.
Here is how someone can become an Habitual Offender.
1. Any combination of 12 convictions for speed, yellow line, operating without a license or operating without proof of financial
responsibility, or
2. 3 major convictions (see below), or
3. 1 major conviction and any combination of 8 of the convictions shown in item 1 above, or
4. 2 major convictions and any combination of 4 of the convictions shown in item 1 above, and
5. These convictions must be within a 5 year period BASED ON DATE OF VIOLATION.
The most common major convictions are:
A. Driving while intoxicated (any such offense)
B. Reckless driving
C. Leaving the scene of (conduct after) an accident
D. Operating after revocation or suspension
E. Taking a vehicle without authority
F. Disobeying a police officer
G. Road racing
STATE OF NEW HAMPSHIRE
UNIFIED COURT SYSTEM
INSTRUCTIONS TO CLEAR NEW HAMPSHIRE DEFAULT
Complete the appropriate section below (#1 if Failure to Respond to Summons; #2 All other), sign it, and ' return it to the agency or court named on
the front upper left corner with the total fine due. The fine amount includes a $50.00 administrative fee assessed pursuant to RSA 502-A: 19-b and/or
RSA 262:44. (If you have defaulted due to a Bad Check an addition fee has been assessed and is included in the amount owed, pursuant to RSA
544-A:2 and must be cleared by certified check or money order).
If the default is with a New Hampshire Court, when the court receives the form correctly completed, with correct fee, a receipt will be issued. The
Division of Motor Vehicles must receive this receipt prior to the effective suspension date, or the suspension will go into effect and you will be
assessed a reinstatement fee by the Division of Motor Vehicles to have your license reinstated (see front of form -- lower left corner). If you do not
include the $50.00 administrative fee with payment of your fine, you will not receive the necessary receipt from the Court and your driving privileges
will be suspended on the date shown above.
If the default is with the Department of Safety and the department does not receive the correctly completed form with the correct fee, including the
$50.00 administrative fee, prior to the effective suspension date, the suspension will go into effect and you will be assessed a reinstatement fee by
the Division of Motor Vehicles to have your license reinstated (see front of form-- lower left corner).
IF NO FINE APPEARS ON THE FRONT, YOU MUST CONTACT THE COURT IN PERSON.
#1 FAILURE TO RESPOND TO SUMMONS:
0 I plead NOT GUlL TV and request a trial (I understand I am to send no money, but must return this form to the agency named on the other side
of this form. I further understand that even if I am found not guilty, I will still be charged the $50.00 administrative fee, which will be payable at
the time of trial.
0 I plead GUlL TY and enclose payment for the total amount due.
0 I plead NOLO CONTENDERE and enclose payment for the total amount due. (I understand that by pleading Nolo Contendere, there will be a
finding of guilty.)
#2 FAILURE TO PAY A FINE, ISSUANCE OF A BAD CHECK or FAILURE TO APPEAR.
0 I wish to clear this default and enclose payment for the total amount due.
(If default was a result of a bad check, payment must be made by certified check or money order.)
Date_-------------
Signature:
Address:
G2548 (05/ 1 0)