Form Sf-0680 - Order For Restricted Driver License

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STATE OF TENNESSEE DEPARTMENT OF SAFETY & HOMELAND SECURITY
ORDER FOR RESTRICTED DRIVER LICENSE
(MUST BE COMPLETED BY THE COURT OF JURISDICTION)
IF YOU HELD A VALID/NON-EXPIRED DRIVER LICENSE ON THE DATE THIS ORDER WAS ISSUED, THE ORDER CAN BE USED AS A 10-DAY
TEMPORARY RESTRICTED LICENSE. YOU MUST APPLY AT A DRIVER SERVICE CENTER FOR A RESTRICTED LICENSE – SEE INSTRUCTIONS ON
BACK.
STATE OF TENNESSEE vs.
(FULL NAME)
DATE OF BIRTH:
DRIVER LICENSE NO:
DATE OF ARREST:
COURT:
COUNTY:
CONVICTION DATE:
DISPOSITION:
DOCKET NO:
Defendant petitioned the court to be considered eligible for restricted license under law effective 7/1/13.  Granted  Not Granted
ORDER
Upon application of the Defendant for a restricted driver license, it appears to the Court that the Defendant has been:
 Convicted of DUI (TCA 55-10-401) and does not have a prior conviction of vehicular homicide, or vehicular assault, or a similar offense in another state, and the
offense was not the proximate cause of death or serious bodily injury to another person (TCA 55-10-409(a))
 Suspended under the implied consent law (TCA 55-10-407 & 55-10-408)
 Revoked for a conviction of drag racing (TCA 55-10-502)
 Suspended for an 18-20 alcohol violation by a minor (TCA 57-5-301) or  a violation of the drug free youth act (TCA 55-10-701)
 Suspended for a conviction of driving away from fuel pump without paying for fuel (TCA 39-14-151)
It further appears to the Court that the Defendant needs a restricted driver license for the purposes set forth in TCA 55-10-409 and TCA 55-50-502(c)(3). This
restricted license is temporary and subject to revocation, if the Department determines you are not eligible pursuant to the above statutory laws. This is only valid
until the Department has had an opportunity to make a final determination of eligibility for a restricted license.
IGNITION INTERLOCK DEVICE (IID)
FAILURE TO MARK APPROPRIATE BOX WILL RESULT IN RESTRICTED LICENSE BEING
DENIED BY THE DEPARTMENT UNTIL A CORRECTED COURT ORDER IS RECEIVED
IGNITION INTERLOCK DEVICE REQUIRED? (Mark all that apply):
 NO, MUST LIST GEOGRAPHIC
 YES, BAC .08% OR HIGHER
 YES, PERSON UNDER 18 IN VEHICLE
RESTRICTIONS BELOW
TCA 55-10-409(b)(2)(B)(i)
TCA 55-10-409(b)(2)(B)(ii)
 YES, ACCIDENT DUE TO DUI
 YES, VIOLATION OF IMPLIED CONSENT AND PRIOR CONVICTION (PAST FIVE
YEARS) FOR TCA 55-10-409(b)(2)(B)(iv):  IMPLIED CONSENT(a)  UNDERAGE DWI (b)
TCA 55-10-409(b)(2)(B)(iii)
 OPEN CONTAINER(c)  RECKLESS DRIVING REDUCED FROM DUI(d)
 YES, PRIOR DUI WITHIN 10 YEARS
 YES, DRIVER REQUESTED
 YES, COURT DISCRETION
 TCA 55-10-409(b)(1)(B)(i)
 TCA 55-10-409(b)(2)(D) or  TCA 55-50-502
TCA 55-10-409(b)(2)(C)
 TCA 55-10-409(d)(2)
 TCA 55-10-409(b)(1)(A)(ii)
Interlock required after reinstatement:  No  Yes:  TCA 55-10-417(a)(1) Time _______ (months) or  TCA 55-10-417(/) (6 months)
(Note to IID Provider: An IID Provider shall not install an IID until the above information is supplied by the Court)
GEOGRAPHIC RESTRICTIONS
 Yes, with Interlock
 Yes, without Interlock
 No
(Note: If no IID is required by law, this Section must be filled out)
Information below must also be completed on all other convictions requiring geographic restrictions. Furnish complete name and
address (street #, street name, city & state) of each location being requested. If you have geographic restrictions, these are the ONLY
locations or dates/times you will be authorized to operate a motor vehicle. Your correct home address should appear on your restricted
driver license.
 Employer
Address:
Type of Employment:
 College/University
Name:
Address:
 Court Ordered Alcohol Safety Program
Name:
Address:
 Meeting/Function with Probation Officer
Name:
Address:
 Regular Place of Worship
Name:
Address:
 Scheduled Interlock Monitoring Appointment
Name:
Address:
 Outpatient Alcohol/Drug Treatment Program
Name:
Address:
 Authorized to drive Employer's vehicles without Ignition Interlock Device, provided proof the employer is aware of the restriction is kept in
vehicle.
Permitted Days:  Sun  Mon Tues  Wed  Thurs  Fri  Sat
Permitted Driving Hours: (State from time you leave home until return): __________ AM to ___________ PM
It is therefore ORDERED that the Defendant be issued a restricted driver license for the purposes and with the conditions set forth above, subject to state laws and
the rules and regulations of the Department of Safety and Homeland Security of the State of Tennessee.
DATE
JUDGE'S SIGNATURE
COURT NAME & SEAL
SF-0680 (Rev. 12/13)
RDA 1348

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