Petition For Early Reinstatement With Ignition Interlock Device Petition Form

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For BMV Use Only
Interlock Approval Date: ____________________
Interlock Requirement End Date: ______________
Department of the Secretary of State
Bureau of Motor Vehicles
Petition for Early Reinstatement with Ignition Interlock Device
You must submit the $50.00 application fee prior to consideration of your petition. This
petition will only be accepted if the following information is fully completed. In order to be
eligible for early restoration with ignition interlock, the driver education, evaluation and
treatment program (D.E.E.P.) must be completed in full, and all other requirements of
restoration must be met.
If a request for early restoration is denied, a person may request an administrative hearing before
the Secretary of State pursuant to 29-A MRSA, § 111 and 2483 and Chapter 2 of the Rules of the
Secretary of State.
Name: ____________________________________ Date of Birth: _______________
License #:___________________
Mailing Address: _____________________________________________________________________________________
Telephone Number: ________________________________________
List Each Vehicle Owned, Leased, or Driven by the Operator:
Make: _______________
Model: ___________
Registration #:____________
VIN #__________________________
Make: _______________
Model: ___________
Registration #:____________
VIN #__________________________
I understand that, as long as I have an ignition interlock device restriction, I may not operate any vehicle that
does not have a functioning ignition interlock device. You must have in your possession a valid license with
appropriate markings prior to driving.
I further understand that if I commit any violation of 29-A MRSA, § 2508 or Chapter 8 Rules for Ignition
Interlock it will result in the immediate suspension of my driving privileges.
____________________________________________ _______________
Signature of Applicant
Mail completed petition to:
Bureau of Motor Vehicles, OUI/HO Section
29 State House Station, 101 Hospital Street
Augusta, Maine 04333-0029
Phone: 207-624-9000, ext. 52104 TTY Users call Maine relay 711
Revised 2/4/2015


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