H R test | Utah Driver License Division (DLD) Web Site

H R

*TEST Page 5/28/25* DO NOT USE

Please complete this form to submit your request. If you need to submit additional information with the request, please attach documentation by attaching the file below

If your request is submitted more than ten (10) calendar days after the date of arrest, complete this form, attach supporting documentation below, and upload a file from your computer explaining:

Why your request is late.
Why a late h should be granted.
Why you believe you will prevail at the h.

Driver Information

Full Name

Driver License Number

Social Security Number

Date of Birth

Phone Number

Enter your full mailing address

Applicant address

City

State

Zip Code

Arrest Information

Date of Arrest

Citation Number

County of Arrest

Requested Attendance Method (Required)

Via Telephone or Web ConferenceIn-Person at a Driver License Division Office

If all parties have requested to attend the hearing via live audiovisual means the hearing may be held in a county designated by the division./>

Attorney Information (if applicable)

Attorney Name

Attorney Address

City

State

Zip Code

Retained (attach supporting documents if requesting discovery)Not Retained

Verification

Email address of individual making request

Type full name to sign form

Type full name to Signature of individual making request - type your name here

Late Request Information - explain the following:
1. Why your hearing request is late
2. Why a late hearing should be granted
3. Why you believe you will prevail at the hearing

Attorney Information - if requesting discovery

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