STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF DRIVER LICENSES
BUREAU OF ADMINISTRATIVE REVIEWS
Application For Formal Review Hearing
Dated:
Reason Suspended: Breath test/ Refusal/ Blood test
Citation Number:
Date Of Citation:
County Citation Issued:
Driver License Number:
State:
License Surrendered:
Full Name:
Date Of Birth:
Residence Address:
Mailing Address If Different:
___________________________
Name
Address
Phone
Fax
For a printable sample 42 day permit form click Florida DUI temporary license form.
After requesting a formal review you or your attorney will have to fill out a pre-hearing statement within 10 days. If the pre-hearing statement is not filled out the review will become an informal review without witnesses. If witnesses are required subpoenas should be sent in with the pre-hearing statement. At this stage it is beneficial to have an attorney because the process becomes more complex. To obtain the initial permit is not as complicated and can be accomplished without an attorney.
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF DRIVER LICENSES
BUREAU OF ADMINISTRATIVE REVIEWS
NAME:
D.L. #:
CITATION NO:
HEARING DATE:
TIME:
LOCATION:
DRIVER’S PREHEARING STATEMENT
1) I am in the process of retaining Attorney’s name, address; phone (pick one) I will be
self-represented your name, your address, your phone
2) Attach subpoena (s) for DHSMV seal and signature with enclosed stamped, self-
addressed envelope. List below the names and addresses of all witnesses that you are asking to
appear at the hearing.
Name.........................Address...............................Testimony.......................Req. Subp.
Officer’s name.............Police station address............Yes/No............................Yes/No
3) Estimated time necessary to present your case: ONE HOUR
I certify that a copy of this Pre-hearing Statement has been mailed or delivered to the Department
on the _____ day of __________, 20__, at __________________________________________
____________________________
Name
Address
Phone
Fax
For a printable sample pre-hearing statement form click pre-hearing statement. A pre-hearing statement form will be mailed to you or handed to you when you obtain the temporary permit.