Certification To Department Of State (Interlock Pilot Project)
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Certification To Department Of State (Interlock Pilot Project) Form. This is a Michigan form and can be use in Criminal Statewide.
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Tags: Certification To Department Of State (Interlock Pilot Project), MC 393, Michigan Statewide, Criminal
Original - Court
1st copy - Department of State
Approved for pilot use, SCAO
STATE OF MICHIGAN
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
Court
CASE NO.
CERTIFICATION TO DEPARTMENT OF STATE
(INTERLOCK PILOT PROJECT)
address
Court telephone no.
Defendant's name, address, and telephone no.
The State of Michigan
THE PEOPLE OF
v
DLN
DOB
TO: Department of State
1. The defendant has been admitted into the DWI/sobriety court program and an approved, certified ignition interlock
device has been installed in each motor vehicle owned or operated by the defendant as required under MCL 257.625k
and MCL 257.625l.
2. The defendant has successfully completed the DWI/sobriety court program.
3. The defendant has been removed from the DWI/sobriety court program before successful completion because the defendant
a. operated a motor vehicle that was not equipped with an ignition interlock device.
b. tampered with or circumvented the ignition interlock device.
c. removed the ignition interlock device(s) without approval.
d. has been charged with a new violation of MCL 257.625.
Date
Judge
Bar no.
.
MC 393 (12/10)
CERTIFICATION TO DEPARTMENT OF STATE (INTERLOCK PILOT PROJECT)
MCL 257.304, MCL 600.1084
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