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    MVD Hearing Request

    Uploaded by

    Vicki Lusk
    This document is a request form for a hearing with the New Mexico Taxation & Revenue Department Motor Vehicle Division. It requests information about the requestor and the reason for the hearing, whether it is contesting a driver's license revocation under the Implied Consent Act, a suspension for failure to pay child support, or another action taken by the MVD. The completed form must be hand delivered or mailed to the MVD Driver Services Bureau by a specified date in order to request the administrative hearing.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    MVD Hearing Request

    Uploaded by

    Vicki Lusk
    24 views1 page
    This document is a request form for a hearing with the New Mexico Taxation & Revenue Department Motor Vehicle Division. It requests information about the requestor and the reason for the hearing, whether it is contesting a driver's license revocation under the Implied Consent Act, a suspension for failure to pay child support, or another action taken by the MVD. The completed form must be hand delivered or mailed to the MVD Driver Services Bureau by a specified date in order to request the administrative hearing.

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    Mvd Hearing Request

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    This document is a request form for a hearing with the New Mexico Taxation & Revenue Department Motor Vehicle Division. It requests information about the requestor and the reason for the hearing, whether it is contesting a driver's license revocation under the Implied Consent Act, a suspension for failure to pay child support, or another action taken by the MVD. The completed form must be hand delivered or mailed to the MVD Driver Services Bureau by a specified date in order to request the administrative hearing.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    24 views1 page

    MVD Hearing Request

    Uploaded by

    Vicki Lusk
    This document is a request form for a hearing with the New Mexico Taxation & Revenue Department Motor Vehicle Division. It requests information about the requestor and the reason for the hearing, whether it is contesting a driver's license revocation under the Implied Consent Act, a suspension for failure to pay child support, or another action taken by the MVD. The completed form must be hand delivered or mailed to the MVD Driver Services Bureau by a specified date in order to request the administrative hearing.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

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    MVD

    New Mexico Taxation & Revenue Department, Motor Vehicle Division

    REQUEST FOR HEARING


    Please print or type information. If name has changed since any of the actions below were taken, give former name first, then current name.

    Requestor Information
    Name Address City, State, ZIP Code Date of Birth Home Telephone Number Social Security Number Work Telephone Number Driver's License Number and State DWI Citation Number and Arrest Date

    Reason for Hearing Request


    I hereby request a hearing for the purpose of (check only one box): IMPLIED CONSENT ACT - Contesting the revocation of my driver's license and/or driving privileges based on violation of the Implied Consent Act: Refusal to submit to the breath/blood test; failure of breath/blood test, blood alcohol content (BAG) at or above .08 (or BAG at or above .02 for persons less than 21 years of age, or at or above .04 if the person was driving a commercial motor vehicle). Request must be submitted or postmarked within ten (10) days from the date of receipt of notice of revocation and must include an Administrative Hearing Fee of $25.00 or a sworn Statement of Indigency (form MVD-10813). If you want the officer to be a witness at your hearing, you must so indicate by checking the box below. If you do not check the box below the police officer will not be required to attend the hearing, and the hearing officer will instead rely on an affidavit submitted by the officer. Q I want the officer to be a witness at my hearing. l~) Q CHILD SUPPORT - Contesting the suspension of my driver's license for failure to comply with child support payments under the Parental Responsibility Act. (No hearing fee required.) OTHER - Please state the specific action taken by MVD that you are contesting and the basis of your protest.

    Signature Hand deliver or mail this completed and signed Request for Hearing to: New Mexico Motor Vehicle Division Driver Services Bureau 1100 South St. Francis Drive, Room 2093/P/O. Box 1028 Santa Fe, NM 87504-1028

    Date

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