APPLICATION FOR ADMINISTRATIVE HEARING

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Florida Department of Highway Safety & Motor Vehicles Date received by Bureau of ADMINISTRATIVE Reviews APPLICATION FOR HARDSHIP/ ADMINISTRATIVE HEARING . Full Name Date of Birth _________________________. First Middle or Maiden Last Month/Day/Year Mailing Address ________________________________________ ________________________________________ __________________________. Street City State Zip Code Driver License Number _______________________________ State ___________________. Applicant's Telephone Number: Residence ( ) Work ( ) ___________________________________. REASON SUSPENDED OR REVOKED ________________________________________ ________________________________________ ______. WHY DO YOU NEED TO DRIVE? ________________________________________ ________________________________________ __________.

• At the hearing, you will be required to testify under oath and answer questions, including questions about your driving record and any violations contained therein, and why you should be granted a restricted license. BAR will then issue a written decision as to whether your request for a restricted license is granted or denied.

  Testify, To testify