Department of Motor Vehicles
  Online Adjudication Request 

Please complete the form below to begin the online adjudication process. You must submit any documents or evidence that you want the hearing examiner to consider. You will not be able to add additional documents or photographs after the form has been submitted for processing. The technical requirements for the file format are listed at the end of the form.
Ticket Number (you must complete a separate form for
each ticket that is submitted for mail adjudication)
First Name * 
Last Name * 
Address 1 * 
Address 2   
City * 
State * 
Zip Code * 
Email Address * 
Confirm Email Address * 

           * = Required Field
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