DUII Diversion Form 9 Revision 02/2019 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR WASHINGTON COUNTY State of Oregon Case Number : v . MOTION TO VACATE USE OF IID AS CONDITION OF DUII DIVERSION AGREEMENT, Defendant and DECLARATION IN SUPPORT MOTION I am the defendant in this case. I ask the court to vacate the condition of my diversion agreement requiring me to install and use an approved ignition interlock device. DECLARATION IN SUPPORT I qualify for a medical exemption under Oregon Department of Transportation rules and I have attached the completed medical exemption form; Or All of the following conditions are true and I have attached the appropriate documentation: I installed an approved IID in accordance with the diversion agreement I entered into on (date): I used the approved IID for at least 6 consecutive months since the date of installation, which was (date) I submitted to the court a certificate from the IID service provider that the device has not recorded a negative report for at least 6 months beginning from the time my driving privileges were reinstated AND does not include any time when my license was suspended. I have entered into and am in compliance with any treatment I may have been required to participate in as a condition of my diversion agreement I understand that I will be required to reinstall the IID if I violate the terms of my DUII diversion. Additionally, I will be responsible for all fees associated with a re-installment. Other information: Please provide copies of all supporting documentation to Evaluation Services Certificate of Document Preparation. Check all that apply: I chose this form for myself and completed it without paid help A legal help organization helped me choose or complete this form, but I did not pay money to anyone I was assisted by a court appointed attorney Evaluation Services helped me choose or complete this form I paid (or will pay) for help choosing, completing, or reviewing this form I hereby declare that the above statements are true to the best of my knowledge and belief. I understand they are made for use as evidence in court and I am subject to penalty for perjury. Date Signature Name (printed) Address City/State/Zip Phone American LegalNet, Inc. www.FormsWorkFlow.com