STATE OF FLORIDA IN THE COUNTY COURT
vs FLAGLER COUNTY, FLORIDA
__________________________________ ___________________________________________
Defendant Citation(s) and/or Case(s)
REQUEST FOR DRIVING PRIVILEGE REINSTATEMENT
I have requested a Hearing Date under Florida Statutes 318.15 (c) A person who is charged with a traffic infraction may
request a hearing within 180 days after the date upon which the violation occurred, regardless of any action taken by the court
or the department to suspend the person’s driving privilege, and, upon request, the clerk must set the case for hearing. The
person shall be given a form for requesting that his or her driving privilege be reinstated.
I request my driving privileges be reinstated until further order of the Court.
My mailing address is (please type or print clearly)
Address
City, State, Zip + 4
Phone Number
Signature Date
SWORN TO AND SUBSCRIBED before me this day of , 20____.
Deputy Clerk
Certificate, Acknowledgment in an Individual Capacity (Florida)
State of Florida
County of
The foregoing instrument was acknowledged before me by means of (how the individual appeared; check one).
Physical presence or online notarization this day of , 20
(Date) (Month) (Year)
By
(Name of Individual Acknowledging)
Individual Identification by: Personal Knowledge Satisfactory Evidence, Type:
Signature of Notary Public
, Notary Public
(Typed, Printed or Stamped Name of Notary Public)
(Affix FL Notary Stamp above)
No action taken
Request Approved With Costs / Without Costs
Request Denied
Judge’s Signature Date
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