IN THE COUNTY COURT OF POLK COUNTY, FLORIA

CIVIL DIVISION

CASE NO. _________________

Plaintiff,

vs.

Defendant.

____________________________________________/

    I, _______________________________________________, am the Defendant in the captioned cause. My driving privileges were suspended because I have not paid the Final Judgment entered against me. The Plaintiff and I have been unable to agree on a monthly or weekly payment schedule.

    I currently have liability insurance.

    I request a hearing pursuant to Florida Statute 324.141 to allow the Court to restore my driving privileges pending timely payment of the judgment in installments of $___________ per ______________ until paid in full.

    I hereby certify that I have sent a copy of this Motion to the Plaintiff at ______________________
_____________________________________________________, this _____ day of _________________________, 19_____.

                                                                                                                            ______________________________________

                                                                                                                            Defendant

                                                                                                                            Address:

                                                                                                                            ______________________________________

                                                                                                                            ______________________________________

154.DOC (05/97)