Oklahoma Highway Patrol Troop S

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Motor Carrier Safety Administrative Hearing Request
This request form is intended for individuals challenging the civil penalties assessed in the Notice of Claim for Out-of-Service violations from a roadside inspection.
* Indicates Required Field
NOTE: This Form must be completed and submitted within 25 days of the date the Notice of Claim was sent.
*Date of Request: (Format: mm/dd/yyyy)
*Commercial Vehicle Examiniation Report Number:
*Motor Carrier:
*Motor Carrier mailing address:
*DOT Number:
*Person making request:
*Phone Number: (no dashes e.g. 5554443333)
Email Address:
Mailing address for notice of hearing (if different from carrier address):
Please use the Notice of Claim sent to you from the Oklahoma Highway Patrol - Troop S to complete the following Sections. Only those Out-of-Service violations which a Civil Penalty has been assessed may be challenged.
Section I
The Motor Carrier ADMITS the following Out-of-Service Violations listed on the Notice of Claim, and understands that these violations will not be heard by the Administrative Hearing Officer. The Motor Carrier further understands that by ADMITTING to the following Out-of-Service Violations the civil penalty listed for the individual violation on the Notice of Claim will be owed to the State of Oklahoma, Department of Public Safety, Troop S.
ADMITTED OUT-OF-SERVICE VIOLATIONS (Please list by Violation Number - example: 393.25F ) For Multiple Violations please list each one on a new line.
Section II
The Motor Carrier CHALLENGES the following Out-of-Service Violations listed on the Notice of Claim, and understands that these violations will be heard by the Hearing Officer at the Administrative hearing.
CHALLENGED OUT-OF-SERVICE VIOLATIONS (Please list by Violation Number - example: 393.25F ) For Multiple Violations please list each one on a new line.
By submitting this hearing request I stipulate to the waiver of compliance with 75 O.S. § 311 and agree and request to have the Notice of Hearing and Order mailed to the above stated mailing address by standard first class mail postage prepaid.
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Motor Carrier Safety Administrative Hearing Request