Ignition Interlock Removal Authorization

The following client is authorized to have their Ignition Interlock Device removed as of the date noted below.

Smart Start may require the Ignition Interlock Device removal form in order to remove the device from a motor vehicle. Without the Interlock removal order, we may not be able to authorize early removal for the driver.
This form is intended for state authorities to approve the removal of an Ignition Interlock device.

Please refer to the Device Removal page if you have completed your program and are attempting to have an Ignition Interlock removed from your vehicle.

"* (required)" indicates required fields

Client Name* (required)

State of Conviction* (required)

Date of Birth* (required)

Driver's License

Case Number* (required)

Removal Authorized On or After* (required)

Authorized By* (required)

Email* (required)

Phone* (required)

File Uploads

Please upload any official documentation that may be required to authorize the Ignition Interlock removal.

Drop files here or

Accepted file types: jpeg, jpg, png, pdf, doc, docx, xls, xlsx, Max. file size: 50 MB, Max. files: 5.

Additional Information

Authorization Approval* (required)

By clicking Submit, you are authorizing the removal/de-enrollment of the breath alcohol monitoring (Ignition Interlock) device for the person named herein.

Comments

This field is for validation purposes and should be left unchanged.