Hsmv72034 Details

HSMV 72034 Form is a form that is used to apply for or renew a Florida driver license. The form can be filled out and submitted online or in person at a driver license office. In order to complete the form, you will need to provide your name, date of birth, Social Security number, and other relevant information. You will also need to provide proof of your identity and residency in Florida. The fee for a new driver's license is $48.50, and the fee for a renewal is $48.50. If you are applying for a commercial driver's license, the fees vary depending on the type of CDL you are applying for.

These are some information about hsmv 72034 form. It'll present you with the likely time you will need to complete the form and several further details.

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

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 Ho urs - Mo nda y t hrough Fr ida y 8:00 a . m. to 5:00 p . m.

Jackso nvil le Orla ndo - Office Ho urs Mo nda y t hro ugh Fr ida y 7:00 a . m. t o 6:00 p . m .

City

 

Address

Office Number

Fax Number

Clearwater

4585

140th Avenue North, Suite 1002

(727)

507-4405

(727) 507-4406

 

 

 

 

 

Daytona Beach

995 Orange Avenue

(386)

254-3912

(386) 238-4744

 

 

 

 

 

 

Ft. Myers

4048

Evans Avenue, Suite 305

(239)

278-7421

(239) 278-7643

Ft. Pierce

3220

South Federal Highway, Suite 8

(772)

468-4050

(772) 460-3662

Gainesville

2815

N.W. 13th Street, Suite 302

(352)

955-2030

(352) 334-1597

Jacksonville

7439

Wilson Boulevard

(904)

777-2132

(904) 777-2133

Lantana

1299

West Lantana Road

(561)

540-1190

(561) 540-1198

Lauderdale Lakes

3718-3 W. Oakland Park Blvd

(954)

677-5800

(954) 714-3550

Melbourne

2325

S. Babcock Street

(321)

984-4910

(321) 984-4851

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

Panama City

237-A W. 15th Street (Lincoln Center)

(850)

872 7745

(850) 872-7675

 

 

 

 

 

Pensacola

100 Stumpfield Road

(850)

494-5728

(850) 494-5837

 

 

 

 

 

 

Tallahassee

2900

Apalachee Parkway Room B-141

(850)

617-2449

(850) 617-5077

 

 

 

 

 

 

Tampa

2814

East Hillsborough Avenue

(813)

276-5795

(813) 276-5797

 

 

 

 

 

Winter Springs

154 Tuskawilla Road Suite 1368

(407)

327-6678

(407) 327-6672

 

 

 

 

 

 

HSMV 72034 (09/2015)

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