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    Request For Local Hearing Red Light Violation

    Uploaded by

    jack frost
    This document is a request form for a local hearing regarding a red light violation. It contains fields for the requestor to provide their contact information as well as details of the notice of violation such as the date, tag number, driver's license number, and issuing authority. It also provides contact information for the local hearing officer who will preside over the requested hearing. The second page is an affidavit where the requestor acknowledges forfeiting their ability to contest the delivery of the notice of violation by requesting the hearing. They also acknowledge responsibilities and penalties associated with the hearing process including fines and fees if the violation is affirmed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Request For Local Hearing Red Light Violation

    Uploaded by

    jack frost
    27 views2 pages
    This document is a request form for a local hearing regarding a red light violation. It contains fields for the requestor to provide their contact information as well as details of the notice of violation such as the date, tag number, driver's license number, and issuing authority. It also provides contact information for the local hearing officer who will preside over the requested hearing. The second page is an affidavit where the requestor acknowledges forfeiting their ability to contest the delivery of the notice of violation by requesting the hearing. They also acknowledge responsibilities and penalties associated with the hearing process including fines and fees if the violation is affirmed.

    Original Description:

    Red Light Camera

    Original Title

    75710

    Copyright

    © © All Rights Reserved

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    This document is a request form for a local hearing regarding a red light violation. It contains fields for the requestor to provide their contact information as well as details of the notice of violation such as the date, tag number, driver's license number, and issuing authority. It also provides contact information for the local hearing officer who will preside over the requested hearing. The second page is an affidavit where the requestor acknowledges forfeiting their ability to contest the delivery of the notice of violation by requesting the hearing. They also acknowledge responsibilities and penalties associated with the hearing process including fines and fees if the violation is affirmed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    27 views2 pages

    Request For Local Hearing Red Light Violation

    Uploaded by

    jack frost
    This document is a request form for a local hearing regarding a red light violation. It contains fields for the requestor to provide their contact information as well as details of the notice of violation such as the date, tag number, driver's license number, and issuing authority. It also provides contact information for the local hearing officer who will preside over the requested hearing. The second page is an affidavit where the requestor acknowledges forfeiting their ability to contest the delivery of the notice of violation by requesting the hearing. They also acknowledge responsibilities and penalties associated with the hearing process including fines and fees if the violation is affirmed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    REQUEST FOR LOCAL HEARING

    RED LIGHT VIOLATION

    Driver/Vehicle Owner and Notice of Violation Information (NOV) (To be provided by requestor)

    Date: _____________________________

    Name (Typed or Printed): ________________________________________________________

    Mailing Address: ______________________________________________________________

    ______________________________________________________________

    City: _________________________ State: ________________ Zip: _____________

    Telephone Number: ____________________________ Fax: _________________________

    E-mail: _______________________________________________________________________

    NOV Number: _______________________________________

    NOV Date: ___________

    Tag Number: _________________ Driver License Number ___________________________

    Agency/Issuing Authority: ______________________________________________________

    Issuing Officer/Agent Name: ____________________________________________________

    Badge #: _______________

    Local Hearing Officer Information (To be provided by local authority)

    Local Hearing Officer: ________________________________________________

    Address: ____________________________________________________________________

    City: ________________________ State: ________________ Zip: ____________

    POC Telephone Number: _________________________ Fax: ________________________

    THIS PAGE OF THE DOCUMENT MUST BE INCLUDED WITH THE AFFIDAVIT ON THE NEXT
    PAGE!

    HSMV 75710
    Affidavit Requesting Hearing and Forfeiting Ability to Contest Delivery

    I ________________________________________________
    do hereby request a formal hearing
    (NAME)

    before a hearing officer in the county of ___________________________ . . I understand that I must submit
    (COUNTY)
    this request to the clerk for the assigned local hearing officer within 60 days from the date posted on the Notice

    of Violation (NOV). I understand that by filing a request for this hearing, I waive my ability to contest the

    delivery of the NOV as set forth in F.S.S. 316.083 (c) and (d). I understand that I have the option to reschedule

    a hearing once by notifying the appropriate clerk for the local hearing officer in writing at least 5 days prior to

    the scheduled hearing. I understand that if I do not reschedule my hearing and I fail to appear for this hearing

    that I will be adjudicated guilty and I am responsible for all fines and/or fees and that a vehicle registration stop

    will be placed on my record. I also understand that if the NOV is affirmed by the local hearing officer, that I am

    responsible for the payment of the original penalty plus up to $250.00 in local fees as set forth in F.S.S. 316.083

    (5). I attest that I fully understand the stipulations of these laws and the associated penalties. Sworn by me on

    and affirmed by my signature below. ________________________________


    (DATE)

    Printed Name: ___________________________________________________________

    Signature of Requestor: ________________________________________________________

    Date Signed: ____________________

    HSMV 75710

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