Alabama hardship driver license Application PDF (DL-22)

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F AX 334.353.99 8 8 E MAIL H ARDSHIP .L ICENSE @ ALEA . GOV APPLICATION FOR HARDSHIP LICENSE Applicant Type (choose all that apply) : Participating in an ADOC regulated work release program 1 Participating in a recognized/compliant Community Corrections Program 1 Released from Alabama Department of Corrections custody as demonstrated by ADOC Form C-80 License suspended/revoked and cannot obtain reasonable transportation 2 Reapplication -Previous Hardship license expired or expiring 3 ** A person who has been adjudicated or convicted of DUI under Alabama Code Section 32-5A-191 is not eligible to apply for a hardship license. Name (First, Middle, Last): _______________________________________________________________________________ Address: _____________________________________________________________________________________________ City, State, Zip: _________________________________________________________________________________________ Social Security No.: ______________________________ AL Driver License No.: _______________________ Date of Birth: __________________________________ Email Address: ______________________________ ___ Daytime Phone Number: ___________________________ I do solemnly swear, affirm, and certify I am the person named herein and the statements on this application, including all required attachments , which are hereby incorporated by this reference, are true and correct. _______________________________________________________________ ________________________________________ Signature of Applicant Date Attachments Required: # 1 - # 3 Required for all applicants *Failure to send the required attachments will result in the rejection of your application* DO NOT WRITE BELOW THIS LINE – FOR DEPARTMENT USE ONLY _________________________________________________ F AX 334.353.99 8 8 E MAIL H ARDSHIP .L ICENSE @ ALEA . GOV APPLICATION FOR HARDSHIP LICENSE Applicant Type (choose all that apply) : Participating in an ADOC regulated work release program 1 Participating in a recognized/compliant Community Corrections Program 1 Released from Alabama Department of Corrections custody as demonstrated by ADOC Form C-80 License suspended/revoked and cannot obtain reasonable transportation 2 Reapplication -Previous Hardship license expired or expiring 3 ** A person who has been adjudicated or convicted of DUI under Alabama Code Section 32-5A-191 is not eligible to apply for a hardship license. Name (First, Middle, Last): _______________________________________________________________________________ Address: _____________________________________________________________________________________________ City, State, Zip: _________________________________________________________________________________________ Social Security No.: ______________________________ AL Driver License No.: _______________________ Date of Birth: __________________________________ Email Address: ______________________________ ___ Daytime Phone Number: ___________________________ I do solemnly swear, affirm, and certify I am the person named herein and the statements on this application, including all required attachments , which are hereby incorporated by this reference, are true and correct. _______________________________________________________________ Signatur o eA pp f licant ________________________________________ Date Attachments Required: # 1 - # 3 Required for all applicants *Failure to send the required attachments will result in the rejection of your application* DO NOT WRITE BELOW THIS LINE – FOR DEPARTMENT USE ONLY _________________________________________________ AAA LA LA LAB A BA BAM A MA MA LL L AA AW W W EE E NN NFF FO R OR OR CC CEME N EMEN EMEN TT T AA A GG GE N EN EN CC CYY Y DD D RR RIVE R IVER IVER LL L IC IC ICE N EN EN SE SE SE DD D IVI IVI IVI SS SIO N ION ION 301 301 301 SS S OUTH OUTH OUTH RR R IPLE IPLE IPLEY Y Y SS S TREETREETREET TT // / P. P. P.O. O. O. B B B OX OX OX 1471 1471 1471 // / MM M ONTGOME ONTGOME ONTGOMERR RYY Y ,,, AL AL AL 3610 3610 36102- 2- 2-1471 1471 1471 P P P HONE HONE HONE 334.676.6002 / ALEA.gov HH H ARDSHIP ARDSHIP ARDSHIP LL L ICENSE ICENSE ICENSE UU U NIT NIT NIT F AX 334.353.99 8 8 E MAIL H ARDSHIP .L ICENSE @ ALEA . GOV APPLICATION FOR HARDSHIP LICENSE Applicant Type (choose all that apply) : Participating in an ADOC regulated work release program 1 Participating in a recognized/compliant Community Corrections Program 1 Released from Alabama Department of Corrections custody as demonstrated by ADOC Form C-80 License suspended/revoked and cannot obtain reasonable transportation 2 Reapplication -Previous Hardship license expired or expiring 3 ** A person who has been adjudicated or convicted of DUI under Alabama Code Section 32-5A-191 is not eligible to apply for a hardship license. Name (First, Middle, Last): _______________________________________________________________________________ Address: _____________________________________________________________________________________________ City, State, Zip: _________________________________________________________________________________________ Social Security No.: ______________________________ AL Driver License No.: _______________________ Date of Birth: __________________________________ Email Address: ______________________________ ___ Daytime Phone Number: ___________________________ I do solemnly swear, affirm, and certify I am the person named herein and the statements on this application, including all required attachments , which are hereby incorporated by this reference, are true and correct. _______________________________________________________________ Signatur o eA pp f licant ________________________________________ Date Attachments Required: # 1 - # 3 Required for all applicants *Failure to send the required attachments will result in the rejection of your application* 1. List and description of all specific vehicles applicant may use (Make, Model, Tag #, Owner's name if not yourself) 2. Provide proof of Mandatory Liability Insurance for each vehicle 3. Statement regarding the inability to obtain reasonable transportation (explain why you need a Hardship license) 4. Proof of SR-22 insurance (if applicable) 5. Letter from Program Director of work release or community corrections program (applies only to 1 designation above) 6. Demonstration of substantial progress toward reinstatement (applies only to 3 designation above) DO NOT WRITE BELOW THIS LINE – FOR DEPARTMENT USE ONLY Application received date: _____________________________ Application approved date: ____________________________ Rejected date: ___________________________ Approved/Rejected by: ______________________________ _ Letter sent date: __________________________ May be submitted via mail, email or fax _________________________________________________ HS2-Revised 06/28/2021 Email sent date: __________________________ Email: FAX: 334-353-9988 EMAIL: HARDSHIP.[email protected] - Mailing Address: Mailing Mailing Address: 2 2