IGNITION INTERLOCK DEVICE INSTALLATION APPLICATION P …

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PART 2 - owner INFORMATION/AUTHORIZATION PART 3 - INSTALLERThe statements and information provided to the Commissioner of Motor Vehicles herein are subscribed by me, the undersigned, under penalty offalse statement, in accordance with the provisions of Sections 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if I makea statement herein which I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to OF CONNECTICUTDEPARTMENT OF MOTOR VEHICLESDRIVER SERVICES DIVISION60 State Street, Wethersfield, CT 06161-1013TELEPHONE: (860) 263-5720IGNITION INTERLOCK DEVICEINSTALLATION APPLICATIONP-246 Rev. 2-2018Complete Part 1 of this form and sign the Operator Certification. If you are not the owner of record for the vehiclelisted, the registered owner must complete and sign Part one of the Connecticut approved vendors to schedule an appointment to install the IGNITION InterlockDevice (IID).

If you are not the owner of record for the vehicle listed, the registered owner must complete and sign Part 2. Contact one of the Connecticut approved vendors to schedule an appointment to install the Ignition Interlock Device (IID). The installer must complete and sign Part 3. Submit the completed form to the address above.

  Owner, Record, Registered, Registered owner, Owner of record