Application For Limited Driving Privileges - Chillicothe Municipal Court, Ohio Page 3
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COURT USE ONLY
Filing fee in the amount of $____________________ received for Application for Limited Driving Privileges on
_____________________, 20_____.
________________________________________
Clerk
_________________________________________________________________________________________________________
LAW DIRECTOR USE ONLY
Application to ALS only:
APPROVED
DENIED - Schedule hearing before Magistrate.
________________________________________
City Law Director
_________________________________________________________________________________________________________
PROBATION DEPARTMENT USE ONLY
OL. #_________________________________________ Expiration Date:_____________________________________________
Date privileges expire:_______________________________________________________________________________________
_________________________________________________
Date Application received by Probation Department
_________________________________________________
_____________________________________________
PROBATION OFFICER
Date Application Examined by Probation Department
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