Request for Administrative License Suspension Hearing

Use this form is to requesting a hearing regarding your license suspension.

I request a hearing for the following reason(s) in reference to my Administrative License Suspension and pursuant to RSA 265-A:31, II.

When submitting this petition for a hearing, please understand that the law requires your request be received in compliance with the law.

The date received by the Bureau of Hearings is the official recorded date when opened and NOT necessarily the date you transmitted the information through this website.

(see Saf-C 2804.02) [for ALS hearings] and (see RSA 265-A:18, VII (e)) [Alcohol Evaluation hearing]

I Request the arresting trooper/officer to be present at the hearing

Do Not

I Request the person conducting the alcohol test be present at the hearing

Do Not

I request that the scientist (as applicable) be present at the hearing.

Do Not

I shall notify the arresting trooper/officer of my request immediately and understand a hearing shall be scheduled within 20 days of this request being received.

I request a waiver of the 20 days and ask the hearing be scheduled as quickly as possible.

Do Not

Today's Date

Date of Arrest

My Full Name

Date of Birth

Mailing Address

City/Town

State

Zip Code

Officer/Trooper Name and Department

Understanding the law listed on this notice, I request a hearing for the following reason(s)

Telephone Number

Email Address