Form Dc 263 PDF Details

At the intersection of legal restoration and personal responsibility, the Commonwealth of Virginia's DC-263 form plays a crucial role for individuals seeking to regain limited driving privileges after suspension. Catering to a variety of needs, this application for a Restricted Driver's License showcases a comprehensive approach to addressing the nuances of suspended licenses due to eligible offenses. The form meticulously outlines provisions for travel to primary and secondary jobs, educational institutions, and essential personal errands, ensuring that the rights to work, education, and care are moderately preserved even when full driving privileges are not. Significantly, it also encompasses provisions for the installation and monitoring of an ignition interlock device, a testament to the balanced aim of allowing mobility while ensuring public safety. Moreover, the form considers the familial obligations of the applicant, including necessary travel for the care of minors and elderly family members, demonstrating a recognition of the interconnectedness of individual and community well-being. As such, the DC-263 form stands as a pivotal document that not only facilitates the path to legal compliance and rehabilitation for drivers but also underscores the judiciary's role in adapting legal frameworks to the practicalities of daily life, striking a balance between restriction and allowance in the journey towards responsible driving.

QuestionAnswer
Form NameForm Dc 263
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdc263 virginia district court forms

Form Preview Example

APPLICATION FOR RESTRICTED DRIVER’S LICENSE

 

Case No.

..........................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commonwealth of Virginia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] General District Court

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

...................................................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] Juvenile & Domestic Relations District Court

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY/COUNTY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.....................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

DEFENDANT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DRIVER’S LICENSE NUMBER

 

 

 

STATE

 

 

 

 

.....................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF BIRTH

 

 

 

 

 

 

 

 

.....................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.................................................................................................................................

 

 

CITY

 

 

 

 

STATE

 

 

 

 

 

ZIP

 

DATE OF OFFENSE

 

 

 

 

 

 

 

 

.....................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My driver’s license has been suspended or denied for an offense which makes me eligible for a restricted

 

 

 

 

 

 

 

 

 

(Court use only)

 

driver’s license; therefore, I request that the court grant a restricted driver’s license for travel to and from the

 

 

 

APPROVED

 

following locations for the following purpose(s):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(a)

[

]

Travel to and from primary job

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Location of Employer:

................................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.....................................................................................................................................................................................................................

 

 

[

] YES [

] NO

 

 

 

 

 

 

Days of Week:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Leave Home:

 

 

 

 

 

 

 

 

 

 

 

 

 

Arrive at Work:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Leave Work:

 

 

 

 

 

 

 

 

 

 

 

.

 

Arrive at Home:

 

.......................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

]

Travel to and from secondary job

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Location of Employer:

.

...............................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.....................................................................................................................................................................................................................

 

 

[

] YES [

] NO

 

 

 

 

 

 

 

 

Days of Week:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

....................................Leave Home:

 

 

 

 

 

 

 

 

 

 

 

Arrive at Work:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.....................................Leave Work:

 

 

 

 

 

 

 

 

 

 

 

 

Arrive at Home:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(b)

[

]

Travel to and from VASAP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES [

] NO

 

(c)

[

]

 

Travel during work hours only as required by my employer:

 

 

 

 

 

[

] YES [

] NO

 

 

 

 

 

 

 

 

Hours of required travel:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.........................................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Written verification must be carried

 

 

 

 

 

[

] YES [

] NO

 

(d)

[

]

Travel to and from school

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Location of school:

......................................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Days of Week:

............................................................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES [

] NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Leave Home:

....................................

 

 

 

 

 

 

 

 

Arrive at School:

......................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Leave School:

 

 

 

 

 

 

 

Arrive at Home:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(e)

[

]

Medically necessary travel for: [

] me

[ ] my elderly parent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] a person residing in my household

 

 

 

 

 

 

[

] YES [

] NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

 

If for elderly parent or another person: Medical provider name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.........................................................................

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Location:

 

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES [

] NO

 

(f-1) Ignition Interlock on any motor vehicle that you operate, if required.

 

 

 

 

 

[ ] and on each

 

 

 

 

 

 

motor vehicle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

owned by or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

registered to person

 

(f-2) [ ] Travel to and from the facility that installed or monitors the ignition interlock in the vehicle(s), if ignition

 

[

] YES [

] NO

 

 

 

 

 

 

interlock is ordered.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(g-1) [

] Necessary travel to transport a minor child(ren), who is/are under my care, to and from his/her/their school.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Location of School:

.............................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES [

] NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dates and Times:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(g-2) [

] Necessary travel to transport a minor child(ren), who is/are under my care, to and from day care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Location of Day Care Provider:

.....................................................................................................................

 

 

 

 

[

] YES [

] NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dates and Times:

 

.......................................................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(g-3) [

] Necessary travel to transport a minor child(ren), who is/are under my care, to and from medical providers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Location of Medical Provider:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES [

] NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dates and Times:

.......................................................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: This is page one of a two-page form.

 

 

 

 

 

 

 

FORM DC-263 (MASTER, PAGE ONE OF TWO) 10/13

Name

. ...........................................................................................................Case No

CONTINUED FROM PAGE 1

(h)[] Necessary travel for Court Ordered visitation with child(ren)

Name(s): ........................................................................................................................................................................................

Location of Child(ren): ............................................................................................................................................................

Days and Times of Visitation: ..............................................................................................................................................

(i-1) [] Travel to and from appointments with probation officer

Name and Location of Probation entity ....................................................................................................................................

(i-2) [] Travel to and from programs required by court or as a condition of probation

Program Name and Location: .....................................................................................................................................................

Program Name and Location: .....................................................................................................................................................

(j)[] Travel to and from a place of religious worship

Name and Location of place of religious worship: ................................................................................................................

......................................................................................................................................Day of Week (one day per week):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Leave Home:

................................................

 

Arrive at place of religious worship:

 

 

 

 

 

 

Leave place of religious worship:

 

 

Arrive Home:

 

 

 

(k)[] Travel to and from appointments approved by the Division of Child Support Enforcement of the Department of Social Services as a requirement of participation in a court-ordered intensive case monitoring program for child support for which I will have with me written proof of the appointment, including written proof of the date and time of the appointment.

(m) [] Travel to and from jail to serve a jail sentence that is to be served on weekends or on nonconsecutive days.

[] YES [ ] NO

[] YES [ ] NO

[] YES [ ] NO

[] YES [ ] NO

[] YES [ ] NO

[ ] YES [ ] NO

Icertify that the above information is true and accurate, that my driving privileges are not revoked or suspended for any other reason, and that I have no other pending charges against me that have not been divulged to the court. I understand that a Restricted Driver’s License permits me to operate a motor vehicle under the conditions approved by the Court. I further understand that should I be found driving outside the restrictions of the Restricted Driver’s License, I may be subject to the imposition of previously suspended sentences in this case and new criminal charges may be brought against me.

 

 

 

__________________________________________________________

........................................................................

 

 

 

 

 

DATE

DEFENDANT’S SIGNATURE

 

 

 

 

Reviewed and Approved as indicated:

 

........................................................................

 

__________________________________________________________

 

DATE

JUDGE

NOTE: This is page two of a two-page form

FORM DC-263 (MASTER, PAGE TWO OF TWO) 07/12

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1. To start off, when filling out the Form Dc 263, start in the part that includes the following fields:

Best ways to fill in Form Dc 263 stage 1

2. Soon after the last selection of blanks is done, go on to type in the applicable details in all these - Days of Week Leave Home Arrive, Travel to and from secondary job, Name and Location of Employer, Days of Week Leave Home Leave, Arrive at Work Arrive at Home, b Travel to and from VASAP c, Hours of required travel Written, d Travel to and from school, Name and Location of school Days, Arrive at School Arrive at Home, e Medically necessary travel for, f Ignition Interlock on any motor, YES NO, YES NO, and YES NO.

Guidelines on how to fill out Form Dc 263 stage 2

3. This subsequent step should also be fairly uncomplicated, f Travel to and from the, interlock is ordered, g Necessary travel to transport, Name and Location of School Dates, g Necessary travel to transport, Name and Location of Day Care, FORM DC MASTER PAGE ONE OF TWO, NOTE This is page one of a twopage, YES NO and on each motor, YES NO, YES NO, YES NO, and YES NO - all these blanks has to be filled out here.

FORM DC MASTER PAGE ONE OF TWO, g   Necessary travel to transport, and Name and Location of Day Care inside Form Dc 263

4. The following section needs your attention in the following places: Name, Case No, h Necessary travel for Court, CONTINUED FROM PAGE, Names Location of Children Days, i Travel to and from, Name and Location of Probation, i Travel to and from programs, Program Name and Location Program, j Travel to and from a place of, Name and Location of place of, YES NO, YES NO, YES NO, and YES NO. It is important to enter all of the required information to move further.

The best way to complete Form Dc 263 step 4

It's very easy to make errors when filling in the YES NO, for that reason ensure that you look again before you decide to send it in.

5. This last stage to conclude this form is pivotal. Make certain you fill in the mandatory blank fields, consisting of m Travel to and from jail to, YES NO, I certify that the above, DATE, Reviewed and Approved as, DATE, DEFENDANTS SIGNATURE, and JUDGE, prior to using the pdf. Otherwise, it can give you an unfinished and possibly nonvalid form!

Writing segment 5 of Form Dc 263

Step 3: Prior to moving forward, check that blank fields have been filled out the right way. The moment you believe it's all fine, click “Done." Obtain the Form Dc 263 the instant you subscribe to a free trial. Easily get access to the form inside your FormsPal cabinet, along with any modifications and changes being conveniently saved! FormsPal provides protected form completion with no data record-keeping or any sort of sharing. Be assured that your information is in good hands with us!