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Get NM MVD-10792 2020-2024

Ame. Requestor Information Name Mailing Address City Email Address Driver License Number Zip Code DOB State State Primary Phone Number DWI Citation Number Arrest Date Reason for Hearing Request I hereby request a hearing for the purpose of: (check only one box) q IMPLIED CONSENT ACT - Contesting the revocation of my driver's license and/or driving privileges based on violation of the Implied Consent Act: Refusal to submit to the breath/blood test; failure of breath/blood test, blood alc.

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