Form DLD23 "Request for Re-examination" - Nevada

What Is Form DLD23?

This is a legal form that was released by the Nevada Department of Motor Vehicles - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2006;
  • The latest edition provided by the Nevada Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DLD23 by clicking the link below or browse more documents and templates provided by the Nevada Department of Motor Vehicles.

ADVERTISEMENT
ADVERTISEMENT

Download Form DLD23 "Request for Re-examination" - Nevada

604 times
Rate (4.7 / 5) 42 votes
Central Services Division
License Review
555 Wright Way
Carson City, NV 89711
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Rural Nevada or Outside Nevada (877) 368-7828
Fax: (775) 684-4829
www.dmvnv.com
Request for Re-Examination
Agency/Individual Requesting Re-Examination
:
(please check one)
Law Enforcement, Badge # ___________
State Agency
Other
Please specify the law enforcement agency, state agency or other facility completing this request:
______________________________________________________________________________________________________
I believe the following driver should be re-examined:
NAME
ADDRESS
SSN
DOB
DRIVER’S LICENSE NUMBER
This driver’s difficulties were brought to my attention because:
The driver was involved in an accident.
The driver committed a traffic violation.
Other (please explain)
I have observed the following:
The driver appears to have a physical disability and/or illness, which appears to affect his/her ability to drive
safely.
The driver appears to have a mental or psychiatric disorder, which interferes with his/her ability to drive
safely.
The driver has had a lapse of consciousness, dizziness, fainting spell, or a seizure due to injury or illness.
Other (please explain)
Please describe the incident; explain the driver’s impairment and how it affects his or her driving ability
(please attach additional sheets as necessary).
Date of Incident
Name (please print)
Signature
Date
Telephone Number
DLD23 (Rev. 7-2006)
Central Services Division
License Review
555 Wright Way
Carson City, NV 89711
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Rural Nevada or Outside Nevada (877) 368-7828
Fax: (775) 684-4829
www.dmvnv.com
Request for Re-Examination
Agency/Individual Requesting Re-Examination
:
(please check one)
Law Enforcement, Badge # ___________
State Agency
Other
Please specify the law enforcement agency, state agency or other facility completing this request:
______________________________________________________________________________________________________
I believe the following driver should be re-examined:
NAME
ADDRESS
SSN
DOB
DRIVER’S LICENSE NUMBER
This driver’s difficulties were brought to my attention because:
The driver was involved in an accident.
The driver committed a traffic violation.
Other (please explain)
I have observed the following:
The driver appears to have a physical disability and/or illness, which appears to affect his/her ability to drive
safely.
The driver appears to have a mental or psychiatric disorder, which interferes with his/her ability to drive
safely.
The driver has had a lapse of consciousness, dizziness, fainting spell, or a seizure due to injury or illness.
Other (please explain)
Please describe the incident; explain the driver’s impairment and how it affects his or her driving ability
(please attach additional sheets as necessary).
Date of Incident
Name (please print)
Signature
Date
Telephone Number
DLD23 (Rev. 7-2006)