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APPLICATION FOR ADMINISTRATIVE HEARING

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? _____. I acknowledge that to knowingly make a false statement or conceal a material fact is fraud and may result in the denial of a hardship license. _____. Signature of Applicant Date After completing this form, you may appear or call one of the Bureau of ADMINISTRATIVE Reviews offices listed below for a HEARING .

Pursuant to Section 322.271, Florida Statutes, you have two options when requesting a restricted license through the Bureau of Administrative Reviews (BAR). Please read this entire application before selecting an option. OPTION 1: EXPEDITED REVIEW • When you select this option, you are requesting BAR waive the requirement that you have a hearing.

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