Arizona Motor Vehicle Division Packet Form PDF Details

The Arizona Motor Vehicle Division Packet form is a crucial step for individuals seeking to reinstate their driving privileges after revocation due to alcohol or drug-related offenses, among other reasons. This detailed packet, addressed to the Driver Improvement Unit in Phoenix, Arizona, outlines specific steps and documents required for the reinstatement process. It emphasizes the importance of determining eligibility before submission, which includes the elapse of the minimum revocation period, the satisfaction of any court judgments, and the resolution of any outstanding warrants or traffic violations. Additionally, it specifies the necessity of SR-22 insurance under certain suspensions and outlines the different components of the packet, including the Revocation Certificate, Court Compliance Statement, and Substance Abuse Evaluation, each serving a distinct purpose in the evaluation of an applicant’s readiness to safely return to the road. The packet also details the roles of qualified health professionals in conducting substance abuse evaluations, underscoring the state’s commitment to ensuring only those who pose no safety risk are allowed back behind the wheel. With all forms and information subject to review by the Motor Vehicle Division, applicants are notified of the final decision in writing, making this packet a comprehensive tool for navigating the complexities of license reinstatement after revocation.

QuestionAnswer
Form NameArizona Motor Vehicle Division Packet Form
Form Length7 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 45 sec
Other namesmvd revocation packet, adot revocation application, revocation packet arizona, revocation application

Form Preview Example

Mail Drop 530M

Driver Improvement Unit

Motor Vehicle Division

PO Box 2100

Phoenix AZ 85001-2100

99-0139 R02/10 www.azdot.gov

REVOCATION

INVESTIGATION PACKET

General Instructions

1. Call before submitting this packet, to determine if you are eligible for reinstatement:

Phoenix 602-255-0072, Tucson 520-629-9808, elsewhere in Arizona 800-251-5866

(Hearing/Speech Impaired–TDD systems only: Phoenix 602-712-3222, elsewhere 800-324-5425)

2.Do not submit this packet more than 30 days after the date that it was signed by a health professional.

3.On form C you must list all DUIs and alcohol/drug related offenses (traffic, criminal and out-of-state), convicted or not.

4.Follow all instructions.

5.Incomplete packets will be returned.

Eligibility Requirements

All of the following criteria must be met before you may submit this investigation packet:

1.Your minimum revocation period has elapsed.

2.If your driving privilege was also suspended, the end of the suspension period must have elapsed as well.

3.If your driving privilege was suspended as a result of a judgment filed against you in court (e.g., for damages arising from a motor vehicle accident), that judgment must also be satisfied. The court in which the judgment was filed is to provide a document to us which indicates that the judgment was satisfied. (A mandatory insurance or financial responsibility suspension1 will not prohibit you from completing this packet. However, some actions may require SR-222 insurance.)

4.If your driving privileges are withdrawn, revoked or suspended in another state, you must satisfactorily complete any requirements necessary to reinstate your privilege to drive in that state.

5.If you have any warrants or pending traffic complaints/violations against you, you must first resolve all court-mandated requirements (e.g., payment of fines or penalties) and obtain a written satisfaction from the court.

6.If you have committed any traffic violations within the preceding 12 months, MVD is not authorized to accept your application for reinstatement until 12 months have elapsed since the date of the violations.

1A “mandatory insurance” or “financial responsibility” suspension generally results from the failure to maintain required minimum levels of insurance on a vehicle titled and registered in your name. Whether the suspension is court-ordered or the result of MVD action, a reinstatement fee will be due at the end of the suspension period. If it is a court-ordered suspension, MVD must receive a clearance from the court before driving privileges can be reinstated. Other actions may also be required, depending on the nature of the suspension.

2An SR-22 is a form of high-risk insurance, or proof of future financial responsibility, which may be required in some insurance-related actions. SR-22 insurance may be purchased from any insurance company authorized to do business in Arizona.

Form Instructions

Revocation Certificate (form A) – for all applicants

1.Print your full name, date of birth, residence and mailing addresses, driver license number and telephone.

2.Provide complete answers to all questions. Do not leave spaces blank.

3.For alcohol/drug related revocations, complete and sign the Authorization To Release Information section.

4.Read the certification statement, then sign and date before a notary public.

5a. For revocations related to alcohol or drugs, submit the Revocation Certificate (form A) to the health professional (see definition on reverse) with the Court Compliance Statement (form B) and Substance Abuse Evaluation (form C); or

5b. For revocations not related to alcohol or drugs, mail only the Revocation Certificate (form

A) to

Mail Drop 530M, Driver Improvement Unit, Motor Vehicle Division, P O Box 2100, Phoenix, AZ

85001-

2100. The Court Compliance Statement and Substance Abuse Evaluation forms will not be needed.

 

Court Compliance Statement (form B) – alcohol/drug related revocations only

1.Print your full name, mailing address, driver license number and date of birth.

2.Sign, date and submit the form to the court in which you were convicted of your last DUI in Arizona.

3.The court must return the form to you.

4.After it is returned by the court, submit the Court Compliance Statement (form B) to the health professional with the Revocation Certificate (form A) and Substance Abuse Evaluation (form C).

Substance Abuse Evaluation (form C) – alcohol/drug related revocations only

1.This form must be completed by the health professional.

2.Submit all three forms to the health professional conducting the evaluation. The health professional must review the Revocation Certificate (form A) and Court Compliance Statement (form B), and complete the Substance Abuse Evaluation (form C).

3.The health professional must submit the original of all three forms to MVD.

4.You are responsible for any expenses required to complete the substance abuse evaluation.

MVD Review – All forms/information are reviewed, and you will be notified in writing of the final decision.

Health Professional – The substance abuse evaluation must be completed by one or more of the following:

Substance abuse counselor who is nationally certified by the Arizona Board of Behavioral Health Examiners, Arizona Department of Health Services or by a comparable board in another state

Substance abuse counselor who is employed by the federal government and who is practicing in this state

Physician or psychologist who is licensed to practice in this state, or in any other state

Physician or psychologist who is employed by the federal government and who is practicing in this state

For a list of eligible substance abuse counselors visit the Motor Vehicle Division website under Driver Services

at www.azdot.gov, or refer to a telephone yellow page directory under Counselor or Alcoholism.

Mail Drop 530M

 

Driver Improvement Unit

REVOCATION CERTIFICATE

Motor Vehicle Division

 

PO Box 2100

All Applicants Must Complete

Phoenix AZ 85001-2100

 

99-0139A R02/10 www.azdot.gov

A

Applicant Name (first, middle, last, suffix)

 

 

Driver License Number

 

Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

City

 

State

Zip

 

 

 

 

 

 

 

 

 

Mailing Address (if different from above)

 

City

 

State

Zip

 

 

 

 

 

 

 

 

 

 

Home Phone

 

 

Daytime Message Phone

 

 

 

 

 

(

)

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Have

you committed any traffic violations in Arizona or in any other state

within the

past

 

 

12 months (CONVICTED OR NOT)? If Yes, please explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Traffic Violations and Dates

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Are you currently employed?

 

 

 

 

 

 

Yes

No

Does your job require you to operate any type of motor vehicle other than on

 

 

 

 

 

private property? If Yes, please explain:

 

 

 

 

 

 

 

 

 

 

 

 

Work-Related Motor Vehicle Operation

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

Have you been through an MVD investigation prior to this investigation?

How many times?

____

 

 

Yes

No

Was a substance abuse evaluation done?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prior Investigations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For Alcohol/Drug Related Revocations Only

Yes

No

Have you completed or are you currently enrolled in any alcohol/drug treatment or education

 

 

programs? If Yes, you may attach any supporting documents.

Authorization To Release Information

Counselor, Physician or Psychologist Name

I hereby authorize the counselor, physician or psychologist above to release to the Motor Vehicle Division any information that is pertinent to my ability to safely operate a motor vehicle, and authorize the Motor Vehicle Division to release to the counselor, physician or psychologist any actions taken on my Arizona driving record prior to and after the investigation.

Applicant Signature

Date

Certification (For All Applicants)

I have read the eligibility requirements and instructions for reinstatement and I am currently eligible to submit this packet. I have answered the above questions to the best of my knowledge. I understand that if my driving privilege is reinstated, any pending offenses or traffic violations that subsequently result in conviction may result in my permission to reinstate being rescinded or my driving privilege being revoked again. I further understand that if a check of another state’s records or a computer check with the National Driver Registry indicates a suspension or revocation still in existence, my license may be canceled or revoked.

Applicant Signature

Notary or MVD Agent Signature

Acknowledged before me this date.

Date

County

State

Commission Expires

 

 

 

 

 

Mail Drop 530M

 

COURT COMPLIANCE

 

Driver Improvement Unit

 

 

Motor Vehicle Division

 

STATEMENT

 

PO Box 2100

 

 

Phoenix AZ 85001-2100

DUI Alcohol/Drug Related Revocations Only

 

 

99-0139B R02/10 www.azdot.gov

 

 

 

 

 

 

Applicant Name (first, middle, last, suffix)

 

Driver License Number

 

Date of Birth

 

 

 

 

 

 

 

 

 

 

 

Mailing Address

City

 

State

Zip

 

 

 

 

 

 

 

B

I am now eligible for reinstatement of my Arizona driving privileges after a revocation. Please provide the following information to be considered by the Motor Vehicle Division.

Applicant Signature

Date

This section must be completed in full

by court clerk, Arizona Department of Corrections (ADC) parole or probation officer, or judge.

Court Name (for last DUI alcohol/drug related offense in Arizona)

Complaint Number

Violation Date

Docket Number

 

 

 

Yes

No

Was alcohol screening ordered?

Yes

No

Was alcohol screening completed?

Yes

No

Was treatment recommended or required? If Yes, please explain:

 

 

 

 

 

Treatment Type

 

 

 

 

 

 

 

 

 

Yes

No

Was treatment completed?

Yes

No

Were the applicant’s records purged?

Please attach copies of any documentation establishing compliance/non-compliance.

Court Clerk, ADC Parole or Probation Officer, or Judge Signature

Phone

()

Date

[Court Seal]

Return Completed Form To Applicant

Mail Drop 530M

DUI-RELATED

Driver Improvement Unit

SUBSTANCE ABUSE

Motor Vehicle Division

PO Box 2100

EVALUATION

Phoenix AZ 85001-2100

99-0139C R02/10 www.azdot.gov

DUI Alcohol/Drug Related Revocations Only

Must be completed in full

by counselor, physician or psychologist.

Applicant Name (first, middle, last, suffix)

Driver License Number

Date of Birth

 

 

 

C

The applicant above is required by state law to have this evaluation completed in order to be considered for reinstatement of driving privileges in Arizona. Your response on this form will indicate to the Motor Vehicle Division how this person’s substance abuse condition may affect or impair his or her ability to safely operate a motor vehicle. For purposes of deciding whether to reinstate the driving privilege, we may rely on your opinion.

History of all DUIs and alcohol/drug related offenses (traffic, criminal and out-of-state), convicted or not.

Offense

Offense Date

Alcohol Level

(required)

Drug Type

(if applicable)

Offense State

(AZ, CA, etc.)

Testing instruments utilized in evaluation (a minimum of two standardized testing instruments are required).

Please specify instrument and scores.

Mortimor-Filkins

SASSI

MAST

DRI

Other (standardized test)

Diagnostic Impressions (DSM IV) – Indicate condition/problem and number of prior contacts. Give facts supporting this diagnosis.

Diagnostic Impressions

Applicant Name (first, middle, last, suffix)

Client Alcohol/Drug Abuse History

Length of Current Abstinence

Family Substance Abuse History

Substance Abuse Education/Treatment History (specify programs and dates)

Client support group history (specify period and frequency):

Alcoholics Anonymous (AA)

 

Sponsor?

 

 

 

YES

NO

 

 

 

 

Narcotics Anonymous (NA)

 

Sponsor?

 

 

 

YES

NO

 

 

 

 

Rational Recovery

 

Sponsor?

 

 

 

YES

NO

 

 

 

Support group history was:

Self disclosed (no documentation)

Verified by documentation of attendance

Prognosis/Observations/Factors (include reasons for opinion)

Recommendations (only if opinion affirmatively indicates an affect upon ability to safely operate a motor vehicle)

Applicant Name (first, middle, last, suffix)

I acknowledge that I have read the Revocation Certificate (form A) and the Court Compliance Statement (form B) and they are complete.

Initials

Based on my evaluation, it is my opinion that the condition of the Applicant:

Does

Does Not affect his or her ability to safely operate a motor vehicle.

Evaluator Certification

State law requires all persons who seek reinstatement of Arizona driving privileges following an alcohol or drug-related revocation must provide the Motor Vehicle Division with a current substance abuse evaluation from a:

Substance abuse counselor who is certified nationally, certified by the Arizona Board of Behavioral Health Examiners, or certified by a comparable board in another state; OR

Substance abuse counselor who is employed by the federal government and who is practicing in this state; OR

Physician or psychologist who is licensed to practice in this state, or in any other state; OR

Physician or psychologist who is employed by the federal government and who is practicing in this state.

I certify that I meet one of the above requirements.

Evaluator Name

Title

Program Name (if applicable)

Mailing Address

City

State

Zip

 

 

 

 

Phone

Professional Certification/License Number

 

 

()

Evaluator Signature

Date

The originals of this form, the Revocation Certificate (form A) and the Court Compliance Statement (form B) along with a copy of your professional certification/license must be mailed to the address below, within 30 days of the signature date, and a copy provided to the Applicant.

MAIL DROP 530M

DRIVER IMPROVEMENT UNIT

MOTOR VEHICLE DIVISION

PO BOX 2100

PHOENIX AZ 85001-2100

How to Edit Arizona Motor Vehicle Division Packet Form Online for Free

adot revocation packet can be filled out easily. Simply open FormsPal PDF editor to get the job done in a timely fashion. To make our tool better and more convenient to utilize, we consistently develop new features, with our users' feedback in mind. It merely requires just a few basic steps:

Step 1: Click on the "Get Form" button above on this page to get into our PDF editor.

Step 2: With the help of this online PDF editor, it's possible to accomplish more than merely complete forms. Try all the functions and make your forms appear perfect with customized textual content put in, or tweak the file's original input to perfection - all comes along with an ability to insert any pictures and sign the PDF off.

Completing this document will require attention to detail. Make sure that every single blank field is filled in accurately.

1. The adot revocation packet will require certain information to be inserted. Ensure the following blanks are finalized:

Part no. 1 of filling out az mvd revocation packet

2. Soon after filling in this part, head on to the subsequent step and complete the essential particulars in these fields - For AlcoholDrug Related, cid Yes cid No, Have you completed or are you, Counselor Physician or, Authorization To Release, I hereby authorize the counselor, Applicant Signature, Date, Certification For All Applicants, I have read the eligibility, Applicant Signature, Acknowledged before me this date, Notary or MVD Agent Signature, Date, and County.

A way to complete az mvd revocation packet part 2

3. Through this step, review B R wwwazdotgov Applicant Name, Driver License Number, Date of Birth, Mailing Address, City, State Zip, I am now eligible for, Applicant Signature, Date, by court clerk Arizona Department, This section must be completed in, Court Name for last DUI, Complaint Number, Violation Date, and Docket Number. These will have to be completed with utmost accuracy.

Completing section 3 in az mvd revocation packet

4. The following paragraph will require your information in the following places: cid Yes cid No Was alcohol, cid Yes cid No Was treatment, Treatment Type, cid Yes cid No Was treatment, cid Yes cid No Were the applicants, Please attach copies of any, Court Clerk ADC Parole or, Phone, Date, and Court Seal. Always enter all requested information to move onward.

Part number 4 for filling out az mvd revocation packet

Be very mindful while filling in Treatment Type and cid Yes cid No Was treatment, since this is the part in which most people make errors.

5. To conclude your form, the last part has some additional fields. Entering Applicant Name first middle last, Driver License Number, Date of Birth, The applicant above is required by, Offense, Offense Date, Alcohol Level, required, Drug Type if applicable, and Offense State AZ CA etc should wrap up the process and you will be done very quickly!

Step # 5 for completing az mvd revocation packet

Step 3: You should make sure your information is right and click "Done" to finish the process. Acquire your adot revocation packet after you join for a free trial. Instantly view the pdf form inside your personal account, together with any modifications and changes automatically kept! FormsPal is devoted to the privacy of all our users; we make sure all information used in our editor stays protected.