Hsmv 72034 Form PDF Details

Driving in Florida comes with certain responsibilities and procedures, especially for those facing suspension due to violations involving breath-alcohol or blood-alcohol levels, or refusal to submit to tests. The Florida Department of Highway Safety & Motor Vehicle's Bureau of Administrative Reviews offers a lifeline in the form of the Hsmv 72034 form. This crucial document serves as a request for eligibility review for drivers seeking to reinstate their driving privileges on a restricted basis, typically for "Business Purposes Only," as detailed under specific Florida Statutes. Applicants are required to understand the conditions, including a $25.00 filing fee and enrollment in a DUI School, for reinstatement. Moreover, acceptance indicates a waiver of the right to any formal or informal review of the suspension under certain statues. The form also outlines the suspension durations for driving with an unlawful alcohol level and the refusal to undergo alcohol tests, setting clear expectations for applicants. Additionally, it provides important details on office locations, hours, and contact information, ensuring that individuals have access to vital resources throughout the process.

QuestionAnswer
Form NameHsmv 72034 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names72034form, request eligibility review, form hsmv 72034, 72034 form printable

Form Preview Example

Florida Department of Highway Safety & Motor Vehicle

Bureau of Administrative Reviews

REQUEST FOR ELIGIBILITY REVIEW

Driver’s Full Name

 

 

 

 

Telephone Number (

)

 

 

 

 

First

Middle or Maiden

Last

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

Street

 

 

City

 

 

State

Zip Code

Driver License Number

 

 

State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I

 

 

 

hereby request a review of my record for the purpose of determining my eligibility for

immediate reinstatement of my driving privilege on a restricted basis as provided in section 322.2615(1)(b)3, Florida Statutes. I understand the restriction is for Business Purposes Only as defined in section 322.271, Florida Statutes and I must pay a $25.00 filing fee, pursuant to section 322.21(9)(a).

I understand that the restricted license will be for the duration of the suspension period imposed under section 322.2615 Florida, Statutes, unless subsequently revoked by the court, as follows:

Driving with an Unlawful Breath-Alcohol or Blood-Alcohol Level = 6 months suspension

Refusal to Submit to a Breath, Blood or Urine Test = 1 year suspension

Reinstatement of the driving privilege on a restricted basis as set forth herein is conditioned on statutory eligibility requirements, including but not limited to enrollment in DUI School.

WAIVER OF FORMAL AND/OR INFORMAL REVIEW

I also understand that acceptance of the reinstated driving privilege as provided in section 322.271(7)(c),

Florida Statutes is deemed a waiver of my right to a formal or informal review under section 322.2615, Florida Statutes.

Signature of Driver

 

Date

Witness Signature

Witness Printed Name

 

Date

Office Hours - Monday through Friday 8:00 a.m. to 5:00 p.m.

City

 

Address

Office Number

Fax Number

Clearwater

4585

140th Avenue North, Suite 1002

(727) 507-4405

(727) 507-4406

Jacksonville

7439

Wilson Boulevard

(904) 777-2132

(904) 777-2133

Lauderdale Lakes

3718-3 W. Oakland Park Blvd

(954) 677-5800

(954) 714-3550

 

 

 

 

 

Miami

7795

W. Flagler Street, Suite 82C

(305) 265-3001

(305) 265-3063

 

 

 

 

 

Orlando

4101

Clarcona-Ocoee Road, Suite 152

(407) 445-5581

(407) 445-5584

 

 

 

 

Pensacola

100 Stumpfield Road

(850) 494-5728

(850) 494-5837

Tallahassee

2900

Apalachee Parkway Room B-154

(850) 617-2449

(850) 617-5077

 

 

 

 

 

Tampa

2814

East Hillsborough Avenue

(813) 276-5795

(813) 231-0817

 

 

 

 

 

HSMV 72034 (12/2019)

How to Edit Hsmv 72034 Form Online for Free

We were designing this PDF editor having the notion of allowing it to be as quick to use as possible. That's the reason the procedure of managing the request eligibility review will undoubtedly be smooth follow these steps:

Step 1: Get the button "Get Form Here" and click it.

Step 2: So you should be within the document edit page. You can include, adjust, highlight, check, cross, insert or delete areas or text.

The following sections are what you will have to fill out to get your finished PDF file.

florida request eligibility review blanks to complete

Write down the data in the I also understand that acceptance, Signature of Driver, Witness Signature, Date, Witness Printed Name, Date, Office Hours Monday through, City, Address, Office Number, Fax Number, Clearwater Jacksonville Lauderdale, and th Avenue North Suite Wilson field.

Entering details in florida request eligibility review part 2

Step 3: As soon as you hit the Done button, the final document is easily exportable to each of your gadgets. Alternatively, you might deliver it via email.

Step 4: Come up with around two or three copies of the file to keep clear of any specific upcoming troubles.

Watch Hsmv 72034 Form Video Instruction

Hsmv 72034 Form isn’t the one you’re looking for?

Related Documents

  • Hsmv 82994 Form

    "... This form must be used for conforming florida title title reassignment supplements. If the title of the vehicle is not electronically transferred, the agent must file the original hsmv82994 and the copies of any hsmv82994 ..."

  • Form Hsmv 86060

    "... Statement of intention to voluntarily surrender dealer license. It is assumed that your intent is to freely relinquish ealer ice nse. You will need to sign a voluntary relinquiishment license agreement. This will be your ..."

  • Hsmv 61518 Form

    "... florida Highway Patrol florida Dot Number Application Mailing Address florida Highway Patrol Commercial Vehicle Enforcement 2900 Pala Chee Parkway ms41 tall has ee FL 32399 or Fax to 850617 5150 Update purposes only: Name of ..."

  • Hsmv 78306

    "... Administrative action is what occurs first. So, the question is: What type of hearing do I need? If you file for formal review, you will get a temporary driver's permit. This temporary permit is issued ..."

Please rate Hsmv 72034 Form

1 Votes

Related Resources

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .