Before completing this application, carefully read and follow the instructions. Failure to follow the instructions may
result in substantial delays in processing the application and/or denial of the petitioner’s application for driving relief.
Petitioners intending to re-establish residency in Illinois within the next 60 days may not apply for driving relief by mail. A
petitioner returning to Illinois must have an in-person hearing with a Secretary of State hearing officer.
Petitioners who have one or more traffic offenses pending in any court in Illinois or any other state may not apply for driving
relief until there is a final disposition such as dismissal, conviction or other resolution of the traffic offense(s) in the court where
the offense(s) is pending.
All petitioners must complete the following requirements:
1. Submit a $50 filing fee in the form of a check or money order payable to Secretary of State, or by credit/debit card using
the form on page 15.
2. A petitioner may obtain a copy of his/her Illinois driving record by submitting a written request along with a $12 check or
money order payable to Secretary of State to: Secretary of State, Driver Services Department, 2701 S. Dirksen Pkwy.,
Springfield, IL 62723. DO NOT SEND CASH. The written request must include the petitioner’s Illinois driver’s
license number, if available, full name and middle initial, date of birth, sex, and be signed and dated.
3.
Out-of-state petitioners must submit evidence of current residency such as voter registration, income tax return, mortgage
contract, employment verification, utility and/or telephone bills, etc. (see page 11). The Department of Administrative
Hearings may reject an out-of-state petition if the petitioner is regularly present in Illinois for such things as work, school or
family contacts and is, therefore, capable of attending a hearing in person. Proof of residency must be dated within 30-60 days
of mailing the application. NOTE: Proof of residency must reflect the same address as reported on the affidavit.
4. A petitioner who has changed his/her name must submit a copy of a marriage certificate, divorce decree or court
order reflecting the name change.
5. Submit the three enclosed Documentation of Abstinence/Character/Substance Use forms. These forms must be signed
and dated, discuss the petitioner’s character and ability to be a safe and responsible driver, and include the frequency and
amount of the petitioner’s alcohol/drug use for at least the last 12 months. Persons completing the forms should know and
see the petitioner on a regular and frequent basis.
6. All petitioners must complete Section I — General Information Affidavit on pages 3-5.
INSTRUCTIONS FOR COMPLETING HEARING APPLICATION
• Petitioners must demonstrate in a clear and convincing manner that they are not a risk to the public’s safety and welfare.
• Petitioners must answer all questions truthfully and to the best of their knowledge. Be specific when answering questions.
• The application must be typed or printed and easy to read.
• Petitioners who have problems reading or following instructions should find someone to assist them in completing the
application.
• Once the Secretary of State receives a completed hearing application, a determination will be made if any other
documentation is required. Petitioners may be required to submit a current Alcohol/Drug Evaluation and comply with any
recommended countermeasures.
•
All applications are handled in the order received. Time will be granted to complete any other requirements. Petitioners
who fail to submit the required documentation in the time allowed will have their applications defaulted and must observe
the waiting requirement before re-applying.
Printed by authority of the State of Illinois. August 2020 — 250 — DAH 00S 6.5