Mc 393 - Certification To Department Of State - State Of Michigan Judicial District
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1Original - Court
1st copy - Department of State
Approved, SCAO
STATE OF MICHIGAN
CASE NO.
JUDICIAL DISTRICT
CERTIFICATION TO DEPARTMENT OF STATE
JUDICIAL CIRCUIT
(INTERLOCK PROGRAM)
Court
address
Court telephone no.
Defendant's name, address, and telephone no.
The State of Michigan
THE PEOPLE OF
v
DLN
DOB
TO: Department of State
1. The defendant has been admitted into the DWI/sobriety court program; and an approved, certified ignition interlock device has
been installed in each motor vehicle owned or operated, or both, by the defendant as required under MCL 257.625k and
MCL 257.625l.
2. The defendant has successfully completed the DWI/sobriety court program.
3. Under MCL 600.1084(6), the Secretary of State is informed that:
a. the court ordered that the defendant be removed from the DWI/sobriety court program before he or she successfully
completed it.
b. the court became aware that the defendant operated a motor vehicle that was not equipped with an interlock device.
c. the court became aware that the defendant
tampered with
circumvented
removed
a court-ordered interlock device without prior court approval.
d. the defendant was charged with a new violation of MCL 257.625.
4. The interlock device was removed from the defendant's vehicle because:
Bar no.
Date
Judge
CERTIFICATION TO DEPARTMENT OF STATE (INTERLOCK PROGRAM)
MCL 257.304, MCL 600.1084
MC 393 (3/15)
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