New Hampshire Administrative License Suspension Review or Hearing Request
NEW HAMPSHIRE ADMINISTRATIVE LICENSE SUSPENSION REVIEW OR HEARING REQUEST
Date: [__/__/____]
To: New Hampshire Department of Safety, Bureau of Hearings
From: [FULL NAME]
Mailing address: [STREET, CITY, STATE, ZIP]
Phone and email: [PHONE; EMAIL]
Driver license or identification number: [NUMBER AND ISSUING STATE]
Notice of suspension issued: [__/__/____]
Notice served or received: [__/__/____]
Arrest date, if shown: [__/__/____]
Notice or case number: [NUMBER]
Request
I request one of the following under RSA 265-A:31 and Saf-C 2804.01:
☐ Administrative review of the suspension or revocation order. I attach the statements or evidence identified below for consideration.
☐ A hearing on the suspension or revocation order. My requests about the officer and test operator appear below.
I ask that the order be rescinded on the grounds I identify in this letter. I understand that filing this request does not pause the suspension or revocation. The Department must receive the request no later than 30 days after the notice was issued. RSA 265-A:31(I)(a); Saf-C 2804.01(a).
Grounds raised
I raise only the checked issues below, to the extent supported by the stated facts. Each corresponds to RSA 265-A:31(II). Grounds omitted from the request may be treated as waived under Saf-C 2804.01(d).
☐ Officer's basis for believing I drove or operated while impaired, or was in actual physical control: [FACTS AND RECORD REFERENCES]
☐ Facts underlying that belief: [SPECIFIC DISPUTED FACTS AND RECORD REFERENCES]
☐ Whether I was arrested: [FACTS AND RECORD REFERENCES]
☐ Refusal or test result: I dispute [WHETHER A TEST WAS REFUSED / WHETHER A PROPERLY ADMINISTERED TEST SHOWED THE APPLICABLE ALCOHOL CONCENTRATION]. My basis is: [FACTS AND RECORD REFERENCES].
☐ Notice of my ability to obtain a similar test from a person of my choosing: [FACTS AND RECORD REFERENCES]
☐ Notice of the license consequences of refusal or an alcohol concentration above the applicable level: [FACTS AND RECORD REFERENCES]
Further explanation of the checked grounds: [____________________________________________________________]
Documents or statements enclosed for administrative review, if selected: [LIST EACH ATTACHMENT]
Hearing attendance requests
Complete this part only if requesting a hearing.
Law enforcement officer:
☐ I request that the officer who signed the suspension report attend the hearing.
☐ I do not request the officer's attendance and understand that the hearing may proceed on the officer's report.
Person who conducted the alcohol test:
☐ I challenge whether the test was properly administered and give notice that I require the person who conducted it to attend the hearing. My basis appears in the refusal or test-result ground above.
☐ I do not require that person's attendance.
Saf-C 2804.01(e), (g) makes these requests part of the hearing request. An omitted officer-attendance election or test-operator notice may waive that attendance.
Please send the written scheduling notice and other communications to [MAILING ADDRESS AND/OR EMAIL].
Respectfully,
Signature: __________________________________ Date: [__/__/____]
Printed name: [FULL NAME]
Filing and officer-copy record
Under Saf-C 2804.01(b), send the signed request to the Bureau of Hearings using one of these routes:
- First-class mail, postage prepaid: Department of Safety, Bureau of Hearings, 33 Hazen Drive, Concord, NH 03305;
- Fax: (603) 271-6653; or
- Email: [email protected].
Saf-C 2804.01(f) also requires mailing a copy to the law enforcement officer at the police department's address. Keep proof of both steps. The address and officer name should be taken from the suspension paperwork.
Bureau filing route: ☐ mail ☐ fax ☐ email
Bureau sent date and time: [__/__/____, TIME] Receipt or confirmation: [DETAILS]
Officer and department: [NAME, DEPARTMENT, MAILING ADDRESS]
Officer copy placed in mail: [__/__/____] Postage/tracking record: [DETAILS]
Official sources
About this template
- Last updated
- November 3, 2026
- Citations checked
- November 3, 2026
- Jurisdiction
- New Hampshire
- Category
- Criminal Law
Legal authority
- RSA 265-A:30(III)-(IV)
- RSA 265-A:31(I)-(II)
- N.H. Admin. R. Saf-C 2804.01 (readopted effective April 2, 2026)
Criminal law paperwork covers every stage of a criminal case, from the first appearance and bail motion through pretrial motions, plea agreements, sentencing, and appeals. Deadlines in criminal cases are short and often unforgiving, and constitutional rights can be waived just by missing a filing. Using the right motion at the right time can mean the difference between evidence getting suppressed, charges getting reduced, or a case getting dismissed entirely.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on November 3, 2026.
RSA 265-A:30(III)-(IV) (checked November 3, 2026): "the suspension shall be effective 30 days after the date of service"
RSA 265-A:31(I)(a) (checked November 3, 2026): "A request for either administrative review or hearing received by the department after 30 days from the date the notice is issued shall be denied as untimely."
RSA 265-A:31(I)(c) (checked November 3, 2026): "If the request is for a hearing, the request shall also indicate whether or not the person desires to have the law enforcement officer present."
N.H. Admin. R. Saf-C 2804.01(b), (f)-(g) (checked November 3, 2026): "The person shall mail a copy of the request for an administrative review or hearing to the law enforcement officer at the police department's address."
Draft your New Hampshire Administrative License Suspension Review or Hearing Request in the editor
Answer a few questions, let the AI editor draft each section from your answers, review it, and download Word and PDF. $99 one time, or $249 per month for every document and every Ezel app.