Form 405 template
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REQUEST FOR ADMINISTRATIVE REVIEW
The document is a request form for an administrative review of a driver's license revocation following the dismissal of a DUI/Refusal charge. The applicant provides their full name, driver's license number, mailing address, date of birth, city/state/zip code, and telephone number. They explain the reason for their request, the expected processing time, and attach a copy of the judgment dismissing the charge.
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