Mv3617 Form PDF Details

Mv3617 form is an important part of the business world. It can be used to create an effective and efficient relationship between a company and its customers. In order to ensure that your mv3617 form is effective, there are a few key things to keep in mind. By following these tips, you can create a form that meets the needs of both your company and your customers.

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QuestionAnswer
Form NameMv3617 Form
Form Length1 pages
Fillable?Yes
Fillable fields46
Avg. time to fill out9 min 31 sec
Other nameswisconsin ignition interlock exemption form, mv3617, mv3617 order for ignition interlock exemptions, mv3617 wisconsin

Form Preview Example

ORDER FOR IGNITION INTERLOCK EXEMPTIONS AND REMOVING TITLE TRANSFER STOPS

Wisconsin Department of Transportation (WisDOT)

MV3617

5/2015

s. 342.12(4) and s. 343.301 Wisconsin Statutes

Clear

Print

 

Court Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5 Digit Court Code

 

 

 

 

 

 

County

 

 

                                                                                         

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver License Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Court Case Number

 

 

 

 

 

 

 

 

 

 

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Defendant Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Birth Date

 

 

 

 

 

 

 

 

 

 

Sex

 

Violation Date (m/d/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Nothing in this order permits the defendant to operate the vehicles identified below while his/her operating privilege remains restricted unless ignition interlocks are installed and used in the vehicles; the court’s order restricting the driver to operating only vehicles equipped with ignition interlock devices remains unchanged.

IGNITION INTERLOCK EXEMPTION

Exempt all mopeds and motorcycles for which the defendant’s name appears on the vehicle’s certificate of title or registration at the

time of this order from ignition interlock

Exempt vehicle(s) listed below from ignition interlock:

 

Year

Make

Vehicle Identification Number (standard VIN has 17 characters)

 

 

 

 

License Plate Number

 

 

 

 

Not Exempt

                   

                             

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Year

Make

Vehicle Identification Number (standard VIN has 17 characters)

 

 

 

 

License Plate Number

 

 

 

 

Not Exempt

                   

                             

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Year

Make

Vehicle Identification Number (standard VIN has 17 characters)

 

 

 

 

License Plate Number

 

 

 

 

Not Exempt

                   

                             

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Year

Make

Vehicle Identification Number (standard VIN has 17 characters)

 

 

 

 

License Plate Number

 

 

 

 

Not Exempt

                   

                             

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Year

Make

Vehicle Identification Number (standard VIN has 17 characters)

 

 

 

 

License Plate Number

 

 

 

 

Not Exempt

                   

                             

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Year

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Vehicle Identification Number (standard VIN has 17 characters)

 

 

 

 

License Plate Number

 

 

 

 

Not Exempt

                   

                             

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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REMOVE TITLE TRANSFER STOP

The court hereby authorizes release of any title-transfer stop imposed by the department under Wis. Stat. s. 342.12(4) for the vehicles identified below.

Year

                   

Make

                             

Vehicle Identification Number (standard VIN has 17 characters)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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License Plate Number

 

 

 

 

 

 

 

 

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Reason for Denial

                             

FAX completed form to (608) 267-6966

OR MAIL to:

Vehicle Records – OWI

Wisconsin Department of Transportation

PO Box 8070, Madison, WI 53708-8070

X

 

                             

FOR QUESTIONS, call (608) 266-1466

(Judge’s Signature)

(Date – m/d/yyyy)

 

 

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step 1 to writing ignition interlock exemption wisconsin

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