Washington IIL

Ignition Interlock Driver License Application.

The information on this page is provided as a convenience for you.  The link above is for the purpose of applying for the Washington State Ignition Interlock LicenseBlow-and-Go Ignition Interlock Systems has no control over whether or not the State will grant you an Ignition Interlock License.

The information below is from google and is a just to give you an idea of how the form looks.  DO NOT use the form below to submit your Washington Ignition Interlock Driver License Application.

Use this link Ignition Interlock Driver License Application to gain immediate access via the DOL form.  You can print the form out and follow the directions as listed.

THIS IS AN EXAMPLE, DO NOT USE.  It is intended to show you the language of the application

Ignition Interlock
Driver License Application
You can use this form to apply for an Ignition Interlock Driver License if you have
been arrested for, or convicted of, an alcohol-related DUI or physical control.
This license can be used to drive while your personal driver license is suspended/
revoked. This license cannot be used to operate a commercial motor vehicle.
To apply, take this application and a $100 non-refundable fee to any driver
licensing office or mail them to:
Driver Records
Department of Licensing
PO Box 9048
Olympia WA 98507-9048
You will be notified of approval or denial in writing.
To be eligible for this license:
· yourdriverecordmustshowthat:
· youhavebeenarrestedfor,orconvictedof,analcohol-relatedDUIorphysicalcontrol.
· yourdriverlicensewasvalidonthedateofconvictionorbeforethedateofanysuspension/revocation.
· youhavenotbeenconvictedofvehicularassaultorvehicularhomicidewithinsevenyearsbeforetheincidentforwhich
you are requesting this license.
· yoursuspension/revocationisnotfor,ordoesnotinclude,minorinpossession,recklessdrivingreducedfromanalcohol-
related DUI, vehicular assault or homicide, or habitual traffic offender.
· youmustsubmitproofoffinancialresponsibilitytous.ThemostcommonisaCertificateofInsurance(SR-22).Contactan
insurance agent for assistance.
· youmusthaveproofofignitioninterlockdeviceinstallationforeveryvehicleyoudrive.Theinstallerwillsendustheproof.
If you drive an employer owned vehicle during working hours, the vehicle may be exempt from this requirement if we have a
signed Employer Declaration on file. This form is available at www.dol.wa.gov.
If you are indigent, you may be eligible for assistance with costs of ignition interlock device installation, removal, and leasing.
To apply for assistance, fill out an Ignition Interlock Device Financial Worksheet available at www.dol.wa.gov.
You waive your right to a hearing or appeal when you receive an Ignition Interlock Driver License.
PRINT OR TYPE — Name of applicant (Last, First, Middle initial)
Washingtondriverlicensenumber
Dateofbirth
(Areacode)Daytimetelephonenumber
Howwouldyoulikeyourlicensesenttoyou?(Checkoneonly)
U.S.mail
email
Fax
Deliveryinformation­mailingaddress,email,or(Areacode)faxnumber
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
______________________________________ ____________________________________________________________
Dateandplace
Signature
RCW46.20.385
The Department of Licensing has a policy of providing equal access to its services.
DR-500-023(N/3/09)W
If you need special accommodation, please call (360) 902-3900 or TTY (360) 664-0116.
Forvalidationonly.106-040-254-0005
IIDL fee_______________Date received ______________
LSRinitials________________Officeno. ______________
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