"Petition for Administrative Hearing for Arrests Occurring on or After January 1, 2012" - Nebraska

Petition for Administrative Hearing for Arrests Occurring on or After January 1, 2012 is a legal document that was released by the Nebraska Department of Motor Vehicles - a government authority operating within Nebraska.

Form Details:

  • Released on August 1, 2015;
  • The latest edition currently provided by the Nebraska Department of 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 printable version of the form by clicking the link below or browse more documents and templates provided by the Nebraska Department of Motor Vehicles.

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Download "Petition for Administrative Hearing for Arrests Occurring on or After January 1, 2012" - Nebraska

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Petition For Administrative Hearing
For arrests occurring on or after January 1, 2012
If you file this Petition, NE residents will NOT be eligible for an ignition interlock until you
have been sentenced in criminal court.
Non-residents’ ignition interlock eligibility is subject to the laws of their
home state.
Complete this Petition to request a hearing to contest the administrative revocation of your
license. The petition must be postmarked within 10 days of either: 1) the mailing date at the
top of the Notice of Administrative License Revocation for BLOOD test result of .08 or over, OR;
2) your arrest date if you had BREATH test result of .08 or over, or if you REFUSED a chemical
test directed by an officer.
I believe my license should not be revoked because: ______________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Name (last, first, middle)
Date of birth
Current mailing address where you want notice sent
City, state, zip code
Home phone
Office phone
Signature
Attorney’s name
Attorney's phone number
Attorney’s address
City and county where arrested
Date of arrest
Law enforcement agency who arrested you
Your driver’s license state and license number
Be sure to enclose the following with this Petition:
1. A photocopy of the Notice/Sworn Report/Temporary License form.
2. All your Nebraska or out-of-state operator’s licenses. If the arresting officer did not take
your license, you must send it in with this Petition. If you do not send in your license, the
Department will deny your Petition.
Completed Petitions must be returned to:
Nebraska Department of Motor Vehicles
Legal Division
P.O. Box 94699
Lincoln, NE 68509-4699
After you file a Petition, you will be mailed a Notice of Hearing. A hearing officer will conduct
the hearing by teleconference. Please consult the Notice of Revocation for the issues you may
address at the hearing. If you have any questions about the Administrative License Revocation,
please call the Legal Division at (402) 471-9593.
August 2015
Petition For Administrative Hearing
For arrests occurring on or after January 1, 2012
If you file this Petition, NE residents will NOT be eligible for an ignition interlock until you
have been sentenced in criminal court.
Non-residents’ ignition interlock eligibility is subject to the laws of their
home state.
Complete this Petition to request a hearing to contest the administrative revocation of your
license. The petition must be postmarked within 10 days of either: 1) the mailing date at the
top of the Notice of Administrative License Revocation for BLOOD test result of .08 or over, OR;
2) your arrest date if you had BREATH test result of .08 or over, or if you REFUSED a chemical
test directed by an officer.
I believe my license should not be revoked because: ______________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Name (last, first, middle)
Date of birth
Current mailing address where you want notice sent
City, state, zip code
Home phone
Office phone
Signature
Attorney’s name
Attorney's phone number
Attorney’s address
City and county where arrested
Date of arrest
Law enforcement agency who arrested you
Your driver’s license state and license number
Be sure to enclose the following with this Petition:
1. A photocopy of the Notice/Sworn Report/Temporary License form.
2. All your Nebraska or out-of-state operator’s licenses. If the arresting officer did not take
your license, you must send it in with this Petition. If you do not send in your license, the
Department will deny your Petition.
Completed Petitions must be returned to:
Nebraska Department of Motor Vehicles
Legal Division
P.O. Box 94699
Lincoln, NE 68509-4699
After you file a Petition, you will be mailed a Notice of Hearing. A hearing officer will conduct
the hearing by teleconference. Please consult the Notice of Revocation for the issues you may
address at the hearing. If you have any questions about the Administrative License Revocation,
please call the Legal Division at (402) 471-9593.
August 2015