Petition for Appeal of Administrative Decision

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____________________________________ § The State Office of

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v. § Administrative Hearings

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TEXAS DEPARTMENT OF PUBLIC SAFETY § __________ County, Texas

PETITION FOR APPEAL OF ADMINISTRATIVE DECISION

TO THE HONORABLE JUDGE OF SAID COURT:

NOW COMES ____________________, hereinafter referred to as Petitioner, whose mailing address is ________________________________________, complaining of the Defendant, TEXAS DEPARTMENT OF PUBLIC SAFETY, and submits this appeal pursuant to the provisions of TTC §524.041. In support of this appeal, Petitioner would respectfully show the following:

I.

Petitioner was issued Texas driver license number ___________.

II.

On the _____ day of ________________, 20___, a hearing was held at the request of the Petitioner and on or...