Source: https://www.911law.com/blog/2014/november/dmv-hearing-request-form/
Timestamp: 2019-04-22 22:44:41+00:00

Document:
This entire document is Copyright © 2000 – Ed Kuwatch (deceased).
For more information please see the notice at the end of it.
I demand a stay of the suspension or revocation pending the hearing and decision, but only for such time as no other driving privilege suspension or revocation is effective.
I demand discovery under Gov. C. §11507.6.
At this time, I object to conducting all or part of the hearing by telephone, television or other electronic means, but may be willing to agree to that later.
Check if applicable: ___ I do not speak English. I will require an interpreter at the hearing who speaks _________________.
At this time, I am representing myself in this matter, but I expect to hire an attorney soon and when I do you’ll be informed of that.
* NOTICE: Vehicle Code §§ 13353.3, 13558 and 40000.1, make it an infraction to fail to hold my hearing and decide the matter prior to the effective date of the suspension or revocation herein, unless the hearing date is continued with good cause or held later with my consent. In addition, Gov. C. §1222 makes it a misdemeanor for a government employee to fail to follow his or her official duty.
If your suspension is for a blood alcohol level over the legal limit, the suspension is for four months, unless you have one or more prior arrests or convictions, in which case it’s for one year.
Many D.M.V. hearings are held and decided far beyond the 30-day deadline, in violation of state law. The D.M.V. defends this lawlessness by saying that the deadline is “directory only” and not “mandatory”. The truth is, Veh. C. §40000.1 and Gov. C. §1222 make it a crime to fail to hold a hearing and decide it before the statutory deadline, unless you agree to a later date or the hearing is continued for good cause beyone the deadline.
In order for your hearing request to be granted, you need not supply the D.M.V. with any additional information, exceeding that provided on this form, which could be used to aid the D.M.V. in its effort to suspend or revoke your driving privileges. This form supplies the D.M.V. with the minimal information legally necessary to obtain the right to have a hearing. The D.M.V. has the right to obtain more information from you later by way of “discovery”, in accordance with state law and their own regulations (Gov. C.§11507.6 and Title 13, Cal. C. of Regs, §115.05), but may not condition granting your initial request for a hearing upon your compliance with a demand for that additional information.
Though there may be some unforeseen risk of consequences for withholding additional information which are not contemplated at this time, it is felt that the benefits of not unnecessarily assisting the D.M.V. in taking your driving privilege outweigh those risks.
As previously stated, this hearing request must usually be made within 10 days of the notice of suspension, which is usually the date you were arrested. It must be actually received by the D.M.V. within that time.
In determining when the 10th day is, begin counting days on the day following the day you were arrested. For instance, if you were arrested on the 5th of the month, start counting with the 6th of the month. The 10th day would be on the 15th of the month. If the last day falls on a weekend or state holiday, the deadline is probably extended to the next business day (Cal. Civil Code §§ 7 through 11, and Cal. Code of Civil Procedure, §§ 12, 12a, 13, 13a), but that’s not a sure thing. Don’t delay your hearing request for this reason.
Fill in all the blanks as appropriate. Your name should be stated exactly as it appears on your driver’s license. This form does not tell the D.M.V. your current mailing address. If the D.M.V. does not have your current mailing address, report a change of address at the closest D.M.V. field office prior to delivering this hearing request to the Driver Safety Division.
The form asks you to write in the exact location of your arrest. This is because Veh. C. §13558, subdivision (b), states that, The hearing shall be held at a place designated by the department as close as practicable to the place where the arrest occurred, unless the parties agree to a different location. If you are unable to give an address, or don’t know the city or town, then state the county where the arrest occurred, and describe the location as best as you can, for example, “Mendocino County on U.S. Highway 101 about 3 miles north of the City of Willits”.
If the D.M.V. contacts you, remember the previous admonition that you have no obligation to tell them any additional information, such as the name of the cop who arrested you, the police agency he or she is employed by, the police report number, etc., in order to obtain a hearing.
Call the number for the field office which is closest to the location of your arrest to determine which office is the correct one to deliver this form to.
WARNING: THE OAKLAND DRIVER SAFETY OFFICE, AND POSSIBLY OTHERS, ROUTINELY FAIL TO ACKNOWLEDGE FAXED HEARING REQUESTS OR FALSELY STATE THAT THE REQUEST WAS RECEIVED AND THE SUSPENSION WAS STAYED WHEN IN FACT THEIR RECORDS WILL FALSELY STATE THAT NEITHER HAS HAPPENED.
YOU MAY NEED TO PERSONALLY DELIVER THE HEARING REQUEST TO A DRIVER SAFETY FIELD OFFICE AND OBTAIN A RECEIPT FOR IT, OR SEND IT TO THEM BY CERTIFIED MAIL. IN EITHER CASE, INCLUDE A COVER LETTER STATING THAT YOU DELIVERED IT AND STATE THE DATE THAT WAS DONE. ALSO STATE YOUR UNDERSTANDING THAT, (1) IT WAS DELIVERED ON TIME, AND (2) A HEARING HAS BEEN GRANTED, AND (3) THE SUSPENSION OR REVOCATION IS STAYED PENDING THAT HEARING AND DECISION.
DO NOT RELY ON AN ORAL STATEMENT THAT YOUR HEARING REQUEST HAS BEEN RECEIVED AND THAT YOUR SUSPENSION IS STAYED PENDING THE HEARING AND DECISION. A LARGE NUMBER OF PEOPLE HAD DONE SO IN LATE 1998 AND HAD BEEN FALSELY ARRESTED AND THEIR CARS WRONGFULLY IMPOUNDED. CARRY THE COVER LETTER WITH YOU, ALONG WITH A COPY OF THIS HEARING REQUEST FORM, AS IT APPEARED WHEN YOU DELIVERED IT, AND YOUR PROOF OF DELIVERY TO THE D.M.V.
Notice: This document was entirely written by Ed Kuwatch and is Copyright © 2000 – Ed Kuwatch. You are welcome to make copies of it so long it is reproduced in its entirely and exactly as it appears here.

References: §11507
 §1222
 §40000
 §1222
 §115
 §13558