SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, COUNTY COURTHOUSE, 220 W. BROADWAY, SAN DIEGO, CA 92101 EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081 SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910 PEOPLE OF THE STATE OF CALIFORNIA FOR COURT USE ONLY DEFENDANT SUPERIOR COURT CASE NUMBER DECLARATION RE: IGNITION INTERLOCK DEVICE DA/CA CASE NUMBER I, the defendant, have been ordered to install a certified Ignition Interlock Device (IID) on any vehicle I own or operate, pursuant to Veh. Code § 23575. I hereby declare as follows: I have installed the IID and proof of installation is attached to this declaration. I do not own (solely or in conjunction with another person or legal entity) or operate any vehicle which would require the installation of an IID. I, the defendant, understand that: I am only allowed to drive a vehicle that is fitted with an operating IID. Installation of an IID on a vehicle does not allow me to drive without a valid driver license. I must have each vehicle fitted with an IID serviced by the installer at least once every 60 days, in order for the installer to recalibrate and monitor the operation of the device. I am not allowed to operate a motorcycle for the duration of the IID restriction period. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Signature of Defendant CRM-275 (New 9/14) Mandatory Form DECLARATION RE: IGNITION INTERLOCK DEVICE American LegalNet, Inc. www.FormsWorkFlow.com