Transcription of ) Exemption Request
{{id}} {{{paragraph}}}
Example: barber
) Exemption Request
A Public Service Agency IGNITION INTERLOCK DEVICE (IID) Exemption Request SECTION 1 DRIVER INFORMATION FULL NAME (FIRST, MIDDLE, L AST) DATE OF BIRTH DRIVER LICENSE NUMBER OR FILE NUMBER RESIDENCE ADDRESS CITY STATE ZIP CODE MAILING ADDRESS CITY STATE ZIP CODE SECTION 2 CONVICTION INFORMATION VIOL ATION DATE CONVICTION DATE SECTION(S) VIOLATED DOCKET NUMBER SECTION 3 Exemption Please indicate the Exemption for which you are applying by checking the appropriate box. IID PROGRAM Exemption I am exempt from the installation of an IID pursuant to California Vehicle Code (CVC) , because I meet all of the following requirements: I do not own a : If you own a vehicle(s) that does not run or for which you have an approved planned non-operation (PNO), you do not qualify for an Exemption .
10. Medical document. 11. Employment document. 12. Insurance document, including medical, dental, vision, life, home, rental, and vehicle. 13. Change of Address Confirmation by the United States Postal Service. 14. Property tax bill or statement. 15. Faith based document that includes the name and address of the issuing organization. 16. Tax ...
Loading..
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: