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 REQUEST FOR ADMINISTRATIVE LICENSE SUSPENSION HEARING


I REQUEST A HEARING FOR THE FOLLOWING REASON (S):

In reference to my Administrative License Suspension and pursuant to RSA 265-A:31, II.


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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 transmit the information through this website.


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

 
1.   I Request the arresting trooper/officer to be present at the hearing    (Select one) **Required
  Do    Do Not   
 
2.   I Request the person conducting the alcohol test be present at the hearing    (Select one) **Required
  Do    Do Not   
 
3.   I request that the scientist (as applicable) be present at the hearing.    (Select one) **Required
  Do    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.  the hearing will be scheduled as quickly as possible in the location where the arrest took place unless it cannot be listed within the timeframe of 20 days and would then be scheduled in Concord.

 
4.   I request a waiver of the 20 days and ask the hearing be scheduled as quickly as possible in the location closest to where the arrest took place    (Select one) **Required
  Do    Do Not   
 
5.   Date of Arrest (Example: MM/DD/YYYY) **Required
 
 
6.   Today's Date (Example: MM/DD/YYYY) **Required
 
 
7.   My Full Name    (Type Answer) **Required
 
(100 character limit; 100 remaining.)
 
8.   Date of Birth (Example: MM/DD/YYYY) **Required
 
 
9.   Mailing Address    (Type Answer) **Required
 
(100 character limit; 100 remaining.)
 
10.   City/Town    (Type Answer) **Required
 
(100 character limit; 100 remaining.)
 
11.   State    (Type Answer) **Required
 
(100 character limit; 100 remaining.)
 
12.   Zip Code    (Type Answer) **Required
 
(100 character limit; 100 remaining.)
 
13.   Officer/Trooper Name and Department    (Type Answer) **Required
 
(100 character limit; 100 remaining.)
 
14.   Understanding the law listed on this notice, I request a hearing for the following reason(s)    (Type Answer) **Required
 
(100 character limit; 100 remaining.)
 
15.   Telephone Number    (Type Answer)
 
(50 character limit; 50 remaining.)
 
16.   Email Address    (Type Answer)
 
(50 character limit; 50 remaining.)
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