California > Statewide > Administrative Hearings And Reexaminations
Self Referral For Reevaluation Of Driving Skill DS 699A - California
| Self Referral For Reevaluation Of Driving Skill Form. This is a California form and can be used in Administrative Hearings And Reexaminations Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
STATE OF CALIFORNIA A Public Service Agency DEPARTMENT OF MOTOR VEHICLES ® SELF REFERRAL FOR REEVALUATION OF DRIVING SKILL INSTRUCTIONS: 1. Please complete this form if you wish the Department of Motor Vehicles (DMV) to reevaluate your ability to drive safely. PLEASE NOTE: Submission of this form to DMV initiates a reexamination of your licensing qualifications and may result in action taken against your driving privilege. DMV will contact you and you may be required to take a vision, written, and/or driving test. DMV may also request medical history information from you and your physician. 2. After completing this form, you may submit it to any DMV office, including the same office where you received it. You may also mail or fax it to a Driver Safety Office. See reverse for the address of the Driver Safety Office nearest your home. YOUR NAME YOUR DRIVER LICENSE NUMBER YOUR BIRTH DATE TELEPHONE NUMBER ( YOUR ADDRESS CITY ) STATE ZIP CODE (OPTIONAL) I AM REQUESTING THIS REEVALUATION BECAUSE: YOUR SIGNATURE TODAY'S DATE X DS 699A (REV. 8/2011 WWW American LegalNet, Inc. www.FormsWorkFlow.com DEPARTMENT OF MOTOR VEHICLES DRIVER SAFETY OFFICES BAKERSFIELD DMV Driver Safety Office 5800 District Blvd., Ste. 100B Bakersfield, CA 93313 FAX: (661) 833-2102 CITY OF COMMERCE DMV Driver Safety Office 5801 E. Slauson Ave., 2nd Flr., Ste. 250 City of Commerce, CA 90040 FAX: (323) 724-9262 COVINA DMV Driver Safety Office 1365 N. Grand Ave., Ste. 101 Van Nuys, CA 91724 FAX: (626) 974-7118 EL SEGUNDO DMV Driver Safety Office 390 N. Sepulveda Blvd., Ste. 2075 El Segundo, CA 90245 FAX: (310) 615-3581/82/83 FRESNO DMV Driver Safety Office 2510 S. East Avenue, Ste. 310 Fresno, CA 93706 FAX: (559) 445-6379 IRVINE DMV Driver Safety Office 16735 Von Karman Ave., Ste. 110 Irvine, CA 92606 FAX: (949) 440-4424 OAKLAND DMV Driver Safety Office 7677 Oakport St., Ste. 220 Oakland, CA 94621 FAX: (510) 563-8950/8951 OXNARD DMV Driver Safety Office 2051 N. Solar Dr., Ste. 200 Oxnard, CA 93036 FAX: (805) 988-1420 REDDING DMV Driver Safety Office 2650 Churn Creek Rd., Ste. 200 Redding, CA 96002 FAX: (530) 224-4715 SACRAMENTO DMV Driver Safety Office 4700 Broadway, 2nd Flr. Sacramento, CA 95820 FAX: (916) 227-0174/2901 SAN BERNARDINO DMV Driver Safety Office 1845 Business Center Dr., Ste. 212 San Bernardino, CA 92408 FAX: (909) 383-7439 SAN DIEGO DMV Driver Safety Office 9174 Sky Park Court, Ste. 200 San Diego, CA 92123 FAX: (858) 627-3925 SAN FRANCISCO DMV Driver Safety Office 1377 Fell Street, 2nd Flr. San Francisco, CA 94117 FAX: (415) 557-7375 SAN JOSE DMV Driver Safety Office 90 Great Oaks Blvd., Ste. 104 San Jose, CA 95119 FAX: (408) 229-7128 VAN NUYS DMV Driver Safety Office 6150 Van Nuys Blvd., Ste. 205 Van Nuys, CA 91401 FAX: (818) 376-4215 DS 699A (REV. 8/2011) WWW American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
