Form Mvd-10236 - Affidavit For Reinstatement Of Driver'S License printable pdf download

MVD–10236

New Mexico Taxation & Revenue Department, Motor Vehicle Division

REV. 12/13

AFFIDAVIT for REINSTATEMENT

of DRIVER’S LICENSE

Note: In order to qualify to reinstate driving privileges, a driver MUST have an ignition interlock

device AND an ignition interlock license (at the same time) for at least 6 months. For example, if an

ignition interlock device is installed on your vehicle on 4/10 but you don’t get an ignition interlock

license until 4/15, the earliest date on which you may be eligible to reinstate your driving privileges is

10/15. If you apply to reinstate your driving privileges before you are eligible, you will be required to

reinstall the ignition interlock device at your own expense.

AFFIDAVIT OF _________________________________

STATE OF NEW MEXICO )

) ss.

COUNTY OF _____________________

I, ___________________________________________, affirm that:

1. I have applied for reinstatement of my driver’s license # ____________________________.

2. I was convicted of DWI on __________________________________.

3. The court ordered me (or MVD required me as a condition of reinstatement) to install an interlock

device and obtain an interlock license for _______ years _______months.

4. I have satisfied the court-ordered requirement.

I installed the interlock device on _____________________________ (date) and had it on my vehicle

for ________ years, ________ months, and ________ days.

6. I obtained the interlock driver’s license on _____________________________ (date) and have had it

for ________ years, ________ months, and ________ days.

7. I have had the interlock device AND interlock license simultaneously for a minimum of 6 months.

8. There have been no instances of tampering with the interlock device.

9. The interlock device was installed and maintained by ______________________________________.

10. The interlock vendor’s/company’s phone number is _______________________________________.

11. I understand that the reinstatement fee is for the application and that, if it is later determined I have not

satisfied all court-ordered and MVD requirements and am not eligible for reinstatement, the fee will

not be refunded and I will be solely responsible for any additional interlock device installation costs.

FURTHER, AFFIANT SAYETH NOT.

_________________________________________________

Signature of Applicant for Reinstatement

Warning: Any person who makes any false affidavit, or knowingly swears or affirms falsely to any

matter required by the Motor Vehicle Code is guilty of perjury, which is a fourth degree felony (Sections

66-5-38 and 30-25-1 NMSA 1978).

Form Mvd-10236 - Affidavit For Reinstatement Of Driver'S License