Defensive Driving Compliant Form
ADVERTISEMENT
1Facsimile (302) 661-7279
Division of Motor Vehicles
DMV-DefensiveDriving@state.de.us
Attn: Defensive Driving
PO Box 698
Dover, Delaware 19903
DEFENSIVE DRIVING COMPLAINT FORM
(Pursuant to 2 DE Admin. Code Reg. 2224, Section 7.0)
Complainant/Filer Information:
PLEASE PRINT OR TYPE
(Last)
(First)
(MI)
NAME:
(Street)
(City)
(State)
(Zip)
ADDRESS:
Daytime Phone #: (
)
Fax #: (
)
E-mail Address:
Before you file a Complaint with the Delaware Division of Motor Vehicles, you should first contact the Course
Provider in an effort to resolve the issue(s). If you do not receive a satisfactory response, then complete this form
and attach copies of any important papers that relate to your complaint. Defensive Driving Complaint Form may be
submitted by fax, mail, or e-mail.
(Course Provider)
(Name of Person You Spoke to)
Date of Alleged Infraction:
Facts of Complaint (If more space is needed please attached additional sheets to the Complaint):
I AUTHORIZE THE COURSE PROVIDER TO FURNISH TO THE DELAWARE DIVISION OF
MOTOR VEHICLES ANY INFORMATION RELATED TO THIS MATTER. I AM ENCLOSING COPIES
OF ANY CORRESPONDENCE OR OTHER PAPERS RELATING TO THIS MATTER WHICH I FEEL
WOULD HELP WITH THE INVESTIGATION. I U NDERSTAND THAT A CO PY OF THIS FORM AND
ANY/OR ALL OF THE ENCLOSED INFORMATION MAY BE SENT TO THE COURSE PROVIDER.
THIS FORM MUST BE SIGNED AND DATED.
Signature
Date
DMV USE ONLY:
Staff Assigned:
Date Received:
15 Days:
Docket #:
Date Sent to Provider:
20 Days:
Course Provider’s Address: _
FAX OR EMAIL TO: 302-661-7279 or
DMV-DefensiveDriving@state.de.us
Form Date: 8/2017
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal