NOTICE OF SUSPENSION TEMPORARY DRIVING PERMIT
DIC-25 (Rev. 10/09)
SUBJECT’S NAME _______________________________ DL/ID NO./STATE _______ DOB______
ADDRESS ___________________________________________________________________
PHYSICAL DESCRIPTION (if unlicensed)
Race: _____ Sex:_____ Height: ______ Weight:_____ Eyes: _____ Hair: _____
DATE OF ARREST: TIME OF ARREST:___________________
COUNTY OF ARREST: _
YOUR LICENSE, PERMIT OR PRIVILEGE TO OPERATE A MOTOR VEHICLE OR WATERCRAFT WILL BE SUSPENDED OR DENIED EFFECTIVE 40
DAYS AFTER THE DATE YOU RECEIVE THIS NOTICE BECAUSE YOU:
ADULT:
- REFUSED to provide a specimen or specimens of breath or blood following an arrest for an offense prohibiting the operation of a motor vehicle or watercraft while intoxicated, while under the influence of alcohol, or while under the influence of a controlled substance.
- PROVIDED a specimen of breath or blood, and an analysis of the specimen showed an alcohol concentration of .08 or greater following an arrest for an offense involving the operation of a motor vehicle or watercraft.
MINOR (Under 21):
- REFUSED to provide a specimen or specimens of breath or blood following an arrest for an offense prohibiting the operation of a motor vehicle or watercraft while intoxicated, while under the influence of alcohol, or while under the influence of a controlled substance.
- PROVIDED a specimen of breath or blood, and an analysis of the specimen showed either an alcohol concentration of .08 or greater or a detectable amount of alcohol following an arrest for an offense involving the operation of a motor vehicle or watercraft.
- WERE NOT REQUESTED TO SUBMIT to the taking of a specimen following an arrest involving the operation of a motor vehicle or watercraft, as the presence of alcohol was detected or measured by other means.
Driver License Confiscated: ☑ Yes ☐ No If no, explain_______________________
_____________________________
Officer’s Signature
_____________________________
Officer’s Printed Name
_____________________________
Agency
Telephone No.___________________
DRIVER INFORMATION
You may request a hearing to contest the suspension by calling (800) 394-9913, faxing (512) 424-2650 or writing the Texas Department of Public Safety, Driver Improvement Bureau, at PO Box 4040, Austin, Texas 78765-4040.All correspondence must include the following information;Full name, date of birth, driver license number and state, current mailing address, home and daytime telephone numbers, date and county of arrest, arresting agency, arresting officer, whether the test was failed, refused or not requested. and such other information as requested by the Department. Please specify if you wish to have your hearing by telephone or in person. The request for hearing must be received by the Texas Department of Public Safety no later
than 15 days after you receive or are presumed to have received notice of suspension.Failure to request a hearing within this time Is a waiver of
your right to a hearing.You will be notified of the date, time, and location of your hearing. You will be required to pay a $125 reinstatement fee to the Texas Department of Public Safety, Driver Improvement Bureau, PO Box 15999, Austin, Texas 78761-5999, in addition to any other fees required by law. See reverse side for periods of suspension and statutory references.
DPS Copy-White Driver’s Copy-Yellow
PERIODS OF SUSPENSION
ADULTS:
Refused to provide a specimen or specimens of breath or blood following an arrest for an offense prohibiting the operation of a motor vehicle or watercraft while intoxicated, while under the influence of alcohol, or while under the influence of a controlled substance (Tex. Transp. Code Ann.
Ch. 724):
180 DAYS
2 YEARS
First Offense
If previously suspended for failing or refusing a breath or blood test or previously suspended for a DWI, Intoxication Assault or
Intoxication Manslaughter conviction during the 10 years preceding the date of arrest.
Provided a specimen of breath or blood with an alcohol concentration of 0.08 or greater following an arrest lor an offense under Section 49.04,
49.07 or 49.08, Penal Code, involving the operation of a motor vehicle or watercraft (Tex. Transp. Code Ami. Ch. 524):
90 DAYS
1 YEAR
First Offense
If previously suspended for failing or refusing a breath or blood test or previously suspended for a OWl, Intoxication Assault or
Intoxication Manslaughter conviction during the 10 years preceding the date of arrest.
MINORS (UNDER 21 YEARS OF AGE):
Refused to provide a specimen or specimens of breath or blood following an arrest for an offense prohibiting the operation of a motor vehicle or watercraft while intoxicated, while under the influence of alcohol or while under the influence of a controlled substance (Tex. Transp. Code Ann. Ch.
724):
180 DAYS
2 YEARS
First Offense
If previously suspended for failing or refusing a breath or. blood test or previously suspended for a OWl, Intoxication Assault or
Intoxication Manslaughter conviction during the 10 years preceding the dale of arrest.
Provided a specimen of breath or blood with an alcohol concentration of 0.08 or greater or a detectable amount of alcohol following an arrest lor an offense under Section 49.04, 49.07 or 49.08, Penal Code, or Section 106.041, Alcoholic Beverage Code, involving the operation of a motor vehicle or watercraft (Tex. Transp. Code Ann. Ch. 524):
60 DAYS
120 DAYS
First Offense
If previously convicted of an offense under Sections 49.04, 49.07 or 49.08, Penal Code, or Section 106.041, Alcoholic Beverage Code, involving the operation of a motor vehicle or watercraft.
180 DAYS
II previously convicted twice or more of an offense under Sections 49.04, 49.07 or 49.08, Penal Code, or Section 106.041, Alcoholic
COMMERCIAL DRIVER LICENSE (COL} HOLDERS: Pursuant to Tex. Transp. Code Ann. Chapter 522, your commercial driving privilege will be disqualified for one year (three years if transporting hazardous material required to be placarded) if you refused to submit to a test under Chapter
724 to determine your alcohol concentration or the presence in .your body of a controlled substance or drug while operating a motor vehicle in a
public place; or if an analysis of your breath or blood under Chapter 524 determines that you had an alcohol concentration of 0.08 or more while operating a motor vehicle, other than a commercial motor vehicle, in a public place.
DRIVER LICENSE REINSTATEMENT FORM
Name DLNo. DOS ____________
Address___________________________________________________
You are required to pay a $125 fee to reinstate your driver license. Payment must be made in the form of a cashier’s check or money order made payable to the Texas Department of Public Safety. Please complete this form and return it, along with your reinstatement fee, to the Texas Department of Public Safety at the following address: DRIVER IMPROVEMENT BUREAU, PO BOX 15999, AUSTIN TX 78761-5999.
DIC-24 (Rev. 9/11)
STATUTORY WARNING
SUBJECT’S NAME_____________________________ DL NO./STATE ___________
DOB PHYSICAL DESCRIPTION (if unlicensed)
Race: Sex: Height: Weight: Eyes: Hair: _
DATE OF ARREST: ____________ TIME OF ARREST: ______
COUNTY OF ARREST: __________
You are under arrest for an offense arising out of acts alleged to have been committed while you were operating a motor vehicle or watercraft in a public place while intoxicated or an offense under Section 106.041, Alcoholic Beverage Code. You will be asked to give a specimen of your breath and/or blood. The specimen will be analyzed to determine the alcohol concentration or the presence of a controlled substance, drug, dan gerous drug or other substance in your body.
If you refuse to give the specimen, that refusal may be admissible in a subsequent prosecution. Your license, permit or privilege to operate a motor vehicle will be suspended or denied for not less than 180 days, whether or not you are subsequently prosecuted for this offense.
If you refuse to submit to the taking of a specimen, the officer may apply for a warrant authorizing a specimen to be taken from you.
If you are 21 years of age or older and submit to the taking of a specimen and an analysis of the specimen shows that you have an alcohol con centration of 0.08 or more, your license, permit or privilege to operate a motor vehicle will be suspended or denied for not less than 90 days, whether or not you are subsequently prosecuted for this offense.
If you are younger than 21 years of age and have any detectable amount of alcohol in your system, your license, permit or privilege to operate a motor vehicle will be suspended or denied for not less than 60 days. However, if you submit to the taking of a specimen and an analysis of the specimen shows that you have an alcohol concentration of less than 0.08, you may be subject to criminal penalties less severe than those pro vided for under Chapter 49, Penal Code.
If you refuse to give the specimen, or if the specimen shows that you have an alcohol concentration of 0.08 or more, you may be disqualified from driving a commercial motor vehicle for a period of not less than one year.
You may request a hearing on the suspension or denial. This request must be received by the Texas Department of Public Safety at its headquar ters in Austin, Texas, no later than 15 days after you receive or are presumed to have received notice of suspension or denial. The request can be made by written demand, fax, or other form prescribed by the Department.
1 certify that I have informed you both orally and in writing of the consequences of refusing to submit to the taking of a specimen or providing a
specimen. I have provided you with a complete and true copy of this statutory warning.
I am now requesting a specimen of your ☐ Breath ☐ Blood
- Subject refused to allow the taking of a specimen and further refused to sign below as requested by this officer.
OR
- Subject refused to allow the taking of a specimen as evidenced by his/her signature below.
__________________________
Subject’s Signature
I further certify that because you are a child as defined in Section 51.02, Family Code, the above request for a specimen and your response have been videotaped.
__________________________
Officer’s Signature
__________________________
Officer’s Printed Name
__________________________
Agency
Telephone No. ___________________
DPS Copy-White Driver’s Copy-Yellow