"Worthless Check - Hardship License Request Form" - Florida

Worthless Check - Hardship License Request Form is a legal document that was released by the Florida Department of Highway Safety and Motor Vehicles - a government authority operating within Florida.

Form Details:

  • The latest edition currently provided by the Florida Department of Highway Safety and Motor Vehicles;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Florida Department of Highway Safety and Motor Vehicles.

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Download "Worthless Check - Hardship License Request Form" - Florida

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Worthless Check - Hardship License Request
Name:
SS#
-----------------
---------------
Florida DL# ___________ _
Telephone# __ _ __ _ ___ _ __ _
Where y ou can be reached between 8:00 a.m. and 5:00 p.m.
__
_
___ _
_________
Mailing Address
_______ _
_____
_
I hereby request an Administrative Hearing to be considered for hardship reinstatement of my driving privilege.
(Signature)
(Date)
To Be Completed By Clerk of Court or State Attorney
Defendant's Name
-------------------------------
Warrant/Case#
SS#
---------------
---------------
D
Defendant has agreed to make restitution pursuant to the terms and conditions set forth by the court.
D
Defendant has established a court date for this case.
Court date:
____________
_
Authorized By:
(Si
'llature)
(Print or type name)
1,
Authorized Agency:
.
D1erk of Court
Dstate Attorney
County ____________________ _
To Be Completed by Clerk of Court in the defendant's resident county
The Above Named Individual:
D Has no traffic cases pending in this county for the past 30 days.
D Has the following traffic cases pending: __________ _
C OU N TY :
__________________
_
A U TH O RIZED
(Signature)
(Date)
Note to Customer: Please mail or fax this completed form to the Division of Driver Licenses,
Bureau
of
Administrative
Reviews.
You.will be contacted for a brief telephonic hearing.
Worthless Check - Hardship License Request
Name:
SS#
-----------------
---------------
Florida DL# ___________ _
Telephone# __ _ __ _ ___ _ __ _
Where y ou can be reached between 8:00 a.m. and 5:00 p.m.
__
_
___ _
_________
Mailing Address
_______ _
_____
_
I hereby request an Administrative Hearing to be considered for hardship reinstatement of my driving privilege.
(Signature)
(Date)
To Be Completed By Clerk of Court or State Attorney
Defendant's Name
-------------------------------
Warrant/Case#
SS#
---------------
---------------
D
Defendant has agreed to make restitution pursuant to the terms and conditions set forth by the court.
D
Defendant has established a court date for this case.
Court date:
____________
_
Authorized By:
(Si
'llature)
(Print or type name)
1,
Authorized Agency:
.
D1erk of Court
Dstate Attorney
County ____________________ _
To Be Completed by Clerk of Court in the defendant's resident county
The Above Named Individual:
D Has no traffic cases pending in this county for the past 30 days.
D Has the following traffic cases pending: __________ _
C OU N TY :
__________________
_
A U TH O RIZED
(Signature)
(Date)
Note to Customer: Please mail or fax this completed form to the Division of Driver Licenses,
Bureau
of
Administrative
Reviews.
You.will be contacted for a brief telephonic hearing.