CR-742 (5/18)(cs) AS 28.15.201(g) REQUEST FOR VERIFICATION IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT STATE OF ALASKA ) Plaintiff, ) vs. ) ) CASE NO. CR ) Defendant. ) AFTER THERAPEUTIC COURT INSTRUCTIONS: This procedure is only available if you have successfully completed Therapeutic Court as part of a court-ordered treatment program under AS 28.35.028. This procedure is only available if you have a past felony conviction for operating a vehicle under the influence of alcohol or a I, , had my license revoked for a felony conviction under AS 28.35.030. I request a verification showing I may be eligible for a limited license because I successfully completed Therapeutic Court as part of a court-ordered treatment program under AS 28.35.028 on the following date: . Date City State ZIP Daytime Phone ORDER Request granted. A certificate of successful completion of Therapeutic Court as part of a court-ordered treatment program is attached. Request denied. Date Judge I certify that on a copy of this order was given or sent to: Clerk: American LegalNet, Inc. www.FormsWorkFlow.com