DEAR FRIENDS:
I HAVE BEEN ARRESTED FOR DUI AND GIVEN A TEMPORARY LICENSE.
PER THIS DOCUMENT I AM REQUESTING AN ADMINISTRATIVE HEARING WITH YOUR DEPARTMENT PURSUANT TO CALIFORNIA VEHICLE CODE §13558.  THE FOLLOWING INFORMATION SHOULD PROVIDE ENOUGH INFORMATION FOR YOU TO SET UP SAID HEARING.

Name:_____________________________________________________

D.M.V. Driver's License No.:______________________________________________

I was arrested for drunk driving (Veh. C. §§ 23140, 23152, 23153 or an equivalent offense) on (date):____________________

Location of arrest, in the State of California at:

________________________________________________________________

The officer's badge number is: ________________

I hereby request a D.M.V. hearing in accordance with the provisions of Veh. C. §13558. I also request a stay of the suspension of my license pending the hearing and decision.

I request discovery under Gov. C §11507.6.

I am requesting a hearing in person in Capitola, California.
 

At this time, I am representing myself in this matter, but I may  hire an attorney and will notify you if I do.

Signature:___________________________________

Date:________________
 

Daytime phone/fax (optional):_______________________________________________