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NOTICE OF DISQUALIFICATION OF COMMERCIAL DRIVING PRIVILEGES

(Pursuant to K.S.A. 8-2,145, and amendments thereto.)

Based upon the certification by one or more law enforcement officers that you have refused to submit to and complete a test requested by a law

enforcement officer or that the test results upon completion of a test showed that you had an alcohol concentration in your breath or blood of .04 or

greater, you are hereby disqualified from driving a commercial motor vehicle, effective twenty (20) days from the date of service of this notice.

The length of the period of disqualification from driving a commercial motor vehicle will be one (1) year unless you were transporting a hazardous

material required to be placarded or you have a prior occurrence of any offense or test refusal or test failure, as defined by K.S.A. 8-2,142, and

amendments thereto.

If you were transporting a hazardous material required to be placarded at the time you refused to submit to and complete a test or the test results upon

completion of a test showed that you had an alcohol concentration in your system of .04 or greater, the length of the period of disqualification from

driving a commercial motor vehicle will be three (3) years.

If you have a prior occurrence of any offense or test refusal or test failure, listed in and as defined by K.S.A. 8-2,142, and amendments thereto, at the

time you refused to submit to and complete a test or the test results upon completion of a test showed that you had an alcohol concentration in your

system of .04 or greater, the length of the period of disqualification from driving a commercial motor vehicle will be for life.

PROCEDURE FOR REQUESTING AN ADMINISTRATIVE HEARING

• If this form was personally served upon you, a hearing request may be made either by mailing a written request which is postmarked within

14 calendar days after the date of service of this form, or by sending a written request by electronic facsimile (fax) to the Division of Vehicles

within 14 calendar days after the date of service of this form.

• If this form was served upon you by mail, a hearing request may be made either by mailing a written request which is postmarked within 17

calendar days after the date of service of this form, or by sending a written request by electronic facsimile (fax) to the Division of Vehicles

within 17 calendar days after the date of service of this form.

• The hearing request must include your full name, driver’s license number and birth date. You should also include a telephone number where you

or your legal representative can be reached if necessary.

• The hearing request must include your current address. If the address you provide in your written request for a hearing is different than the

address on the reverse side of this form, the address in your hearing request will be treated as a change of address pursuant to K.S.A. 8-248. All

correspondence will be sent to the address provided in the hearing request.

• The hearing request must state whether you want to have the certifying officer(s) subpoenaed to the administrative hearing. If you wish to

contest the facts contained in the officer’s certification at the administrative hearing, you have the burden of disproving those facts, and you may

need to compel the appearance of the certifying officer(s) to do so. If you fail to request any officer’s attendance at the time you make a hearing

request, your right to compel that attendance by subpoena will be deemed waived and the Law Enforcement Officer’s Certification will be

admitted as evidence at the hearing.

• You must pay a nonrefundable fee of $50.00 within the time period for making a timely request for a hearing (check or money order preferred).

The $50 hearing fee must be postmarked within the time period for making a timely hearing request or your hearing request will be denied. (A

faxed image of cash or of a check or money order will not be accepted.) Checks should be made payable to: Administrative Hearing

Section, Kansas Department of Revenue.

• HEARING LOCATION. Upon receipt of your timely written hearing request and fee, a hearing will be scheduled for you within the county

where the alleged violation occurred, or a county adjacent thereto, and you will receive by mail written notice of the time, date, and place of the

hearing. Any temporary driving privileges granted on the reverse side of this document will be extended until a final determination is made.

• SUBPOENAING WITNESSES. If you request an administrative hearing, you may request that witnesses be subpoenaed. Any request you

make to issue subpoenas must be made in writing at the time the hearing is requested and must include the name and current address of each

witness requested and, except for the certifying law enforcement officer or officers, a statement of how the testimony of such witness is relevant.

• Mail hearing requests to: DL Administrative Hearing Section

Kansas Department of Revenue

P. O. Box 2744

Topeka, KS 66601-2744

• Send electronic facsimile (fax) requests to:

(785) 296-0275

CDL-5 (Rev. 07/13)

Form Cdl-5 - Officer'S Report And Notice Of Disqualification Of Commercial Driving Privileges Page 2

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