APPLICATION FOR HARDSHIP/ADMINISTRATIVE HEARING
Fu 11Name _________________________________________________________________s Date of B irth ________________________________
FirstMiddle or MaidenLastMonth/Day/Year
Mail ing Address______ ________________-
Street |
City |
State |
Zip Code |
Driver License Number_______________________________ State____________________ |
|
|
Applicant’s Telephone Number: Residence ()_______________________________ Work (}t |
• |
|
REASON SUSPENDED OR REVOKED,______________________________________________________________________________________
WHY DO YOU NEED TO DRIVE?t,________________________________________ _____________________ __________
I acknowledge that to knowingly make a false statement or conceal a materia! 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.
NOTE: A $12.00 filing fee must be collected prior to scheduling your hardship hearing.
A $25.00 filing fee must be collected prior to scheduling your administrative hearing.
Office Hours - Monday through Friday 8:00 a.m. to 5:00 p.m.
Jacksonville Office Hours - Monday through Friday 7:00 a.m. to 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-I41 |
(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 |
FLORIDA DRIVER IMPROVEMENT PROGRAM
Florida Law requires that anyone requesting ahearing for possible early reinstatement of a suspended and/or revoked driving privilege prior to the expiration of such suspension and/or revocation period must enroll in, or complete, the appropriate Driver Improvement or Alcohol/Substance Abuse Education course. You may call the
closest office listed above for your school and other hearing requirements.
YOU MUST PRESENT THE ITEMS MARKED BELOW AT THE TIME OF THE HEARING:
COMPLETION of Advanced Driver Improvement (ADI) OR Driving Under the Influence (DU1) School (CIRCLE ONE)
ENROLLMENT in Advanced Driver Improvement (ADI) OR Driving Under the Influence (DUI) School (CIRCLE ONE)
If this school is not completed within 90 days of enrollment, your driving privilege will be cancelled.
OTHER:
♦*lf eligible, upon request, a telephone hearing may be available which will be determined by the hearing officer. Please call your nearest office listed above.
HSMV 78306 (Rev. 05/15)
