REQUEST FOR ALR HEARING
TO: Texas Department of Public Safety, fax #: (512) 424-2650
Please type or print clearly Date faxed :____________________________
Current Mailing Address (WARNING: DPS may mail notices of hearings and other important information to the address on your driver's license - update it immediately), including City, State, ZIP Code:
Home Telephone Number __________________________________________________________________
Work/daytime Telephone Number ____________________________________________________________
Driver's License Number Issuing State _________________________________________________________
Date of Birth __________________________________________
Date of Arrest _________________________________________________________________
County of Arrest ________________________________________________________________
Arresting Agency ____________________________________________________________________________
Arresting Officer and Badge Number, if known _______________________________________________________
Are you requesting an in-person hearing or telephone hearing? Circle one ---- in-person/telephone
I HEREBY REQUEST A HEARING FOR THE PURPOSE OF (Check only one)
__________ FAILED TEST: Contesting the suspension of my driver's license and/or driving privilege based on alleged failure of breath/blood/urine test, the result being allegedly 0.08 or greater.
__________ REFUSED TEST: Contesting the suspension of my driver's license and/or driving privilege based on alleged refusal of breath/blood/urine test.
******* The request for hearing must be received by the Texas Department of Public Safety no later than fifteen (15) days after you have been served with notice of suspension, which is normally served on the day of arrest. It is advisable that you fax this document and get a printed confirmation that the fax was sent and received before the deadline.
This form is provided as a courtesy by attorney Phillip W. Goff and does not establish an attorney-client relationship.