Form Dc 1014 - Application To Modify A Driver'S License Suspension Or Revocation For Suspension And Revocations
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1
2Division of Vehicles
Central Office Operations
PO Box 12021
Phone: 785-296-3671
915 SW Harrison St
FAX: 785-296-6851
Topeka KS 66612-2021
Nick Jordan, Secretary
Sam Brownback, Governor
Department of Revenue
Donna Shelite, Director of Vehicles
APPLICATION TO MODIFY A DRIVER’S LICENSE SUSPENSION OR REVOCATION
FOR SUSPENSION AND REVOCATIONS IMPOSED PRIOR TO JULY 1, 2011
Beginning July 1, 2011, you may apply to: 1) modify the current suspension or revocation against your driving
privileges due to a DUI conviction, chemical test failure or chemical test refusal (imposed or occurring prior to July 1,
2011); and 2) determine whether you are eligible to have your driving privileges restricted to operating a motor
vehicle equipped with an ignition interlock device for limited driving purposes after serving a mandatory period of
suspension days. Beginning July 1, 2012, you may apply to modify your current ignition interlock restriction period to
1
receive credit for previously served suspension or revocation time served in excess of one year.
The basis for
suspension or revocation must spring from K.S.A. 2011 Supp. 8-1014, or amendments thereto. Your application
must be accompanied by a non-refundable, application fee of $100.00. You will receive written notice of your
application being approved or denied. If approved, you will be required to provide proof of installation of a State-
approved ignition interlock device before a restricted driver’s license is issued. If the application is denied, the
reason(s) for the denial will be stated. PLEASE NOTE: IF YOUR SUSPENSION/REVOCATION SPRINGS FROM
AN ARREST OCCURING AFTER JULY 1, 2011, DO NOT USE THIS FORM – YOUR REQUEST WILL BE DENIED
AND YOUR PAYMENT WILL NOT BE RETURNED.
Section 1, Applicant Information
Name as it appears on your driver’s license (please print):
Date of Birth:
Drivers License Number:
Current Address (Note: if the address provided is different than the most recent address in the Division’s records, this
address will be considered a change of address, pursuant to K.S.A. 8-248, and your driving record will be updated).
Street
City
State
Zip Code
Section 2, Modification of current suspension or revocation and request for restricted driving privileges
Are you requesting the Division of Vehicles to:
A.
Modify the current suspension or revocation of your driving privileges to a one year suspension period
followed by an ignition interlock period (See Section 6 on the back page):
Yes
No
AND/OR
c.
Yes
No
Determine if you should receive credit against your ignition interlock restriction period for suspension or
revocation periods served over and above one year. To be eligible for such credit, you must certify that
you did not drive during the applicable suspension or revocation period.
_______________________________________________________Date:___________________
Certification of Applicant that he/she did not operate a vehicle during suspension or revocation period.
Section 3. Acknowledgement
________________________________________________
_______________________________
Applicant’s Signature
Date
1
See New Section 16(h) of House Substitute for SB 60 (2012).
DC 1014 (rev. 7/12)
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