Form Dc 1015 - Application To Modify Suspension To Restricted Ignition Interlock Driving Privileges
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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 SUSPENSION TO RESTRICTED IGNITION INTERLOCK DRIVING PRIVILEGES
You may apply to the Division of Vehicles for a determination on whether you are eligible to have your driving
privilege suspension modified to a restriction to operating a motor vehicle equipped with an ignition interlock device
for limited driving purposes. To be eligible for the modification, your driving privileges must be suspended for one
year as provided in subsection (a), (b) or (c) of K.S.A. 2011 Supp. 8-1014, and amendments thereto. If your
suspension results from refusal of a chemical test, after 90 days of such suspension, you may apply to the division for
1
your driving privileges to be restricted.
If your suspension results from a test failure or alcohol or drug-related
conviction, after 45 days of such suspension, you may apply to the division for your driving privileges to be
23
restricted.
If your application is granted, the limitations associated with your ignition interlock privileges will permit
vehicle operation for the purposes of getting to and from: Work, school or an alcohol treatment program; and the
ignition interlock provider for maintenance and downloading of data from the device.
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.
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 determine if and when you have served requisite number of
suspension days and are eligible to operate a motor vehicle equipped with an ignition interlock device for limited
driving purposes for the remainder of the one year suspension?
Yes
No
If your suspension springs from an arrest occurring prior to July 1, 2011, a form DC 1014 should accompany this
request. See the Department of Revenue’ website:
Section 3. Acknowledgement
________________________________________________
_______________________________
Applicant’s Signature
Date
1
See Sec. 17(a)(1) of House Substitute for SB 60 (2012).
2
See Sec. 17(a)(2) of House Substitute for SB 60 (2012).
3
If a conviction and administrative refusal are reported for the same arrest, a 90 days of suspension will be required.
DC 1015 (rev. 07/12)
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