Dds Form Ds 665A PDF Details

When facing the suspension of one's driving privileges due to a conviction, navigating the aftermath can feel daunting. However, the DDS DS-665A form, also known as the Application for Limited Driving Permit, offers a glimmer of hope for individuals in such situations. This document is a critical step for those seeking to regain a semblance of their driving capabilities in Georgia, under specific, legally-approved circumstances. Governed by the guidelines set forth in O.C.G.A. §40-5-64, this application process requires the applicant to have already relinquished their driver's license following a conviction, either to the court or directly to the Department of Driver Services. With a non-renewable $25 fee, the permit strictly prohibits the operation of commercial vehicles and limits driving to the state of Georgia. Importantly, eligibility hinges on the applicant's ability to demonstrate "extreme hardship" should the permit not be granted, covering essential activities like employment, attending educational institutions, medical needs, recognized support meetings, court-ordered programs, or visiting an Ignition Interlock provider. The process also outlines steps for those whose requests are initially denied or permits revoked, detailing the right to request a hearing. Understanding the intricacies of the DS-665A form and the associated legal process is vital for those seeking to navigate the potentially life-altering impact of driving privilege suspension.

QuestionAnswer
Form NameDds Form Ds 665A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesgeorgia form 665a, dds 665a, dds application limited driving, form ds 665a 02 070

Form Preview Example

Application for Limited Driving Permit (O.C.G.A. §40-5-64)

Customer Service, Licensing, and Records Division

P.O. Box 80447

Conyers, Georgia 30013

678-413-8400

SECTION 1: Important Information

In accordance with O.C.G.A. §40-5-64, a person may apply to the Department for a Limited Driving Permit immediately following conviction if he or she has surrendered his or her driver's license to the court in which the conviction was adjudged or to the Department if the Department has processed the citation or conviction. The fee for all Limited Driving Permits is $25.00. All Limited Driving Permits are nonrenewable upon expiration. You CANNOT use this permit to operate a commercial motor vehicle. If you are not licensed, or you are licensed in another state, you are not eligible for a Limited Driving Permit. All Limited Driving Permits are valid for use only within the State of Georgia. This application does not confer driving privileges, and cannot be used as a driver’s license or for identification purposes.

(Applicant Initials)________

SECTION 2: Applicant Information

Are you a United States citizen?

Yes

No (Acceptable proof of lawful presence may be required, in accordance with O.C.G.A. §40-5-21.1)

LAST Name

FIRST Name

MIDDLE Name

 

 

 

Date of Birth (mm/dd/yyyy)

 

Georgia Driver’s License Number

 

 

 

Street Address

 

Apartment Number

 

 

 

City

State

Zip Code

SECTION 3: Standards for Approval

(Applicant Initials)_______I do hereby swear or affirm that this petition for the issuance of a Limited Driving Permit is based upon

the fact that refusal of the Department to issue such permit would cause “extreme hardship”.

(Applicant Initials)_______I do hereby swear or affirm that I cannot reasonably obtain other transportation; and therefore, I would be

prohibited from (please check all that apply):

Going to and from my place of employment or performing the normal duties of my occupation;

Receiving scheduled medical care or obtaining prescription drugs;

Attending a college or school at which I am regularly enrolled as a student;

Attending regularly scheduled sessions or meetings of support organizations for persons who have addiction or abuse problems related to alcohol or other drugs, which organizations are recognized by the Commissioner of DDS;

Attending under court order any driver education or improvement school or alcohol or drug program or course approved by the court which entered the judgment of conviction resulting in suspension of my driver's license or by the Commissioner of DDS; and/or,

Going to and from my Ignition Interlock provider.

SECTION 4: Hearing Notice

Any person whose permit has been revoked or who has been refused a permit by the Department may make a request in writing for a hearing to be provided by the Department. Such hearing shall be provided by the Department within 30 days after the receipt of such request and shall follow the procedures required by Chapter 13 of Title 50, the "Georgia Administrative Procedure Act." Appeal from such hearing shall be in accordance with said chapter. Such request shall be made in writing to the Customer Service, Licensing, and Records Division, P.O. Box 80447, Conyers, Georgia 30013.

(Applicant Initials)_________

DS-665A (02/07)

SECTION 5: Revocation of Limited Driving Permit

Any permittee who operates a motor vehicle in violation of any condition specified on the Limited Driving Permit permit shall be guilty of a misdemeanor. In addition, the Department shall revoke a Limited Driving Permit of any permittee:

1.Who is convicted of violating any state law or local ordinance relating to the movement of vehicles;

2.Who is convicted of violating the conditions endorsed on his or her permit;

3.Upon receipt of notice from the Division of Mental Health, Developmental Disabilities, and Addictive Diseases of the Department of Human Resources that a permittee who is required to complete a substance abuse treatment program pursuant to O.C.G.A. §40-5-63.1 enrolled in but failed to attend or complete such program as scheduled; or,

4.Upon receipt of notice from a provider center for ignition interlock devices that an ignition interlock device which a permittee is required to use has been tampered with or the permittee has failed to report for monitoring of such device as required by law.

(Applicant Initials)_________

SECTION 6: Applicant Affirmation (Must be signed before a person authorized to administer oaths)

Under penalty of law, I do hereby swear or affirm that the information I have provided in this application is true and correct. Furthermore, under penalty of law, I do hereby swear or affirm that the court has not imposed a suspension or revocation of my driver's license or driving privileges inconsistent with the driving privileges to be conferred by the limited driving permit applied for herein.

__________________________________________

 

 

 

 

 

 

Signature of Applicant

 

 

 

Date

 

 

 

 

 

 

 

 

Sworn to and subscribed before me

 

 

 

 

 

this ______ day of _____________________, 20_____.

(Notary Seal)

 

 

 

 

 

 

 

 

 

 

 

___________________________________________

 

 

 

 

 

 

Notary Public

 

 

DEPARTMENT USE ONLY

 

 

 

DEPARTMENT USE ONLY

DEPARTMENT USE ONLY

1. Suspension Effective Date: _________________

2. License Class: _________

3. License Type: _________

4. Type of Suspension:

DUI First (DUI)

 

DUI Second (LP2)

ALS First

Points (LPM)

 

Mandatory First (LPM)

School Suspension (SP)

5a. License Surrendered to DDS?

Yes (Date:________________)

No

 

 

5b. Issue Date of License Surrendered to DDS: ________________________

 

 

5c. License Surrendered to Law Enforcement?

 

Yes* (Date:_______________________)

No

**Applicant must show documented proof from law enforcement agency that seized the applicant’s license.

5d. License Surrendered to Court/DS-250A?

Yes* (Date: ________________________)

No

**Applicant must show documented proof from court that seized the applicant’s license.

 

 

A surrender date is required for the issuance of a DUI, LPM, or LP2 permit. If there is no surrender date on the system, applicant MUST complete a DS-250 (Driver’s License Affidavit).

Permit Approved (Date: _______________________)

Permit Denied (Date: _________________________)

Reason for Approval/Denial:

Agency Representative/Examiner: _____________________________________________________________ CSC#:__________

DS-665A (02/07)

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