Transcription of APPLICATION FOR ADMINISTRATIVE HEARING
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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 .
please mail your application to the office nearest your residence for questions, please contact the office nearest your residence via email office address email address phone clearwater 4585 140th ave n., suite 1002, 33762 clearwaterbar@flhsmv.gov (727) 507-4405
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