Request For Hearing printable pdf download

Request For Hearing

Request for Hearing:

I request a hearing before the Driver Assessment and Appeal Division to contest issues

number(s) _____________________________. (Issues are listed below.)

Affirmative Address Statement:

The address on my master driving record is correct. Send all correspondence to

this address.

The address on the reverse side is only a temporary address. Send all

correspondence to this address. Please DO NOT CHANGE the address on my

master driving record file.

If you need to inform the Department of State of a permanent address change, you can

obtain our change of address form by telephone 1-888-SOS-MICH (888-767-6424), by

fax (517) 335-4329 or over the Internet at

Signature_________________________________________ Date ________________

Driver’s License Number _____________________________ Telephone ____________

This request for hearing must be mailed within 14 days of the receipt of the Officer’s

Report of Refusal to Submit to Chemical Test containing the Notice of suspension, or

your operator’s or chauffeur’s license and vehicle group designation or operating

privilege will be suspended. Send this form with your original signature. Do not send a

photocopy.

Mail to: Michigan Department of State

Driver Assessment and Appeal Division

P.O. Box 30196

Lansing, MI 48909-7696

Hearing Issues:

MCL 257.625f limits the issues appealable at a hearing ONLY to the following:

Whether the peace officer had reasonable grounds to believe that you

committed a crime described in MCL 257.625c(1).

Whether you were placed under arrest for a crime described in MCL

257.625c(1).

If you refused to submit to a chemical test upon the request of the officer,

whether the refusal was reasonable.

Whether you were advised of your rights under MCL 257.625a.

Request For Hearing