The Arizona Motor Vehicle Division Packet form is a crucial document for individuals seeking reinstatement of their driving privileges after a revocation. This form guides applicants through the necessary steps and requirements to ensure they meet eligibility criteria. For those ready to take action, fill out the form by clicking the button below.
The Arizona Motor Vehicle Division (MVD) Packet form is an essential document for individuals seeking to reinstate their driving privileges after a revocation, particularly for alcohol or drug-related offenses. This packet includes several key components that must be completed accurately to ensure a smooth reinstatement process. Firstly, applicants are advised to contact the MVD to confirm their eligibility for reinstatement before submitting the packet. It is crucial to adhere to a timeline, as submissions should occur within 30 days of being signed by a health professional. The packet comprises multiple forms, including the Revocation Certificate, Court Compliance Statement, and Substance Abuse Evaluation, each with specific instructions. For instance, individuals must disclose all DUIs and related offenses, regardless of conviction status, and ensure that all questions are fully answered. Additionally, eligibility requirements stipulate that the minimum revocation period must have passed, and any related court judgments must be satisfied. The forms must be completed by a qualified health professional, who will evaluate the applicant's substance use history and its potential impact on their driving ability. Following submission, the MVD will review all provided information and communicate the final decision in writing. Understanding the detailed requirements and instructions outlined in the Arizona MVD Packet form is vital for anyone navigating the reinstatement process.
Mail Drop 530M
Driver Improvement Unit
Motor Vehicle Division
PO Box 2100
Phoenix AZ 85001-2100
99-0139 R02/10 www.azdot.gov
REVOCATION
INVESTIGATION PACKET
General Instructions
1. Call before submitting this packet, to determine if you are eligible for reinstatement:
Phoenix 602-255-0072, Tucson 520-629-9808, elsewhere in Arizona 800-251-5866
(Hearing/Speech Impaired–TDD systems only: Phoenix 602-712-3222, elsewhere 800-324-5425)
2.Do not submit this packet more than 30 days after the date that it was signed by a health professional.
3.On form C you must list all DUIs and alcohol/drug related offenses (traffic, criminal and out-of-state), convicted or not.
4.Follow all instructions.
5.Incomplete packets will be returned.
Eligibility Requirements
All of the following criteria must be met before you may submit this investigation packet:
1.Your minimum revocation period has elapsed.
2.If your driving privilege was also suspended, the end of the suspension period must have elapsed as well.
3.If your driving privilege was suspended as a result of a judgment filed against you in court (e.g., for damages arising from a motor vehicle accident), that judgment must also be satisfied. The court in which the judgment was filed is to provide a document to us which indicates that the judgment was satisfied. (A mandatory insurance or financial responsibility suspension1 will not prohibit you from completing this packet. However, some actions may require SR-222 insurance.)
4.If your driving privileges are withdrawn, revoked or suspended in another state, you must satisfactorily complete any requirements necessary to reinstate your privilege to drive in that state.
5.If you have any warrants or pending traffic complaints/violations against you, you must first resolve all court-mandated requirements (e.g., payment of fines or penalties) and obtain a written satisfaction from the court.
6.If you have committed any traffic violations within the preceding 12 months, MVD is not authorized to accept your application for reinstatement until 12 months have elapsed since the date of the violations.
1A “mandatory insurance” or “financial responsibility” suspension generally results from the failure to maintain required minimum levels of insurance on a vehicle titled and registered in your name. Whether the suspension is court-ordered or the result of MVD action, a reinstatement fee will be due at the end of the suspension period. If it is a court-ordered suspension, MVD must receive a clearance from the court before driving privileges can be reinstated. Other actions may also be required, depending on the nature of the suspension.
2An SR-22 is a form of high-risk insurance, or proof of future financial responsibility, which may be required in some insurance-related actions. SR-22 insurance may be purchased from any insurance company authorized to do business in Arizona.
Form Instructions
Revocation Certificate (form A) – for all applicants
1.Print your full name, date of birth, residence and mailing addresses, driver license number and telephone.
2.Provide complete answers to all questions. Do not leave spaces blank.
3.For alcohol/drug related revocations, complete and sign the Authorization To Release Information section.
4.Read the certification statement, then sign and date before a notary public.
5a. For revocations related to alcohol or drugs, submit the Revocation Certificate (form A) to the health professional (see definition on reverse) with the Court Compliance Statement (form B) and Substance Abuse Evaluation (form C); or
5b. For revocations not related to alcohol or drugs, mail only the Revocation Certificate (form
A) to
Mail Drop 530M, Driver Improvement Unit, Motor Vehicle Division, P O Box 2100, Phoenix, AZ
85001-
2100. The Court Compliance Statement and Substance Abuse Evaluation forms will not be needed.
Court Compliance Statement (form B) – alcohol/drug related revocations only
1.Print your full name, mailing address, driver license number and date of birth.
2.Sign, date and submit the form to the court in which you were convicted of your last DUI in Arizona.
3.The court must return the form to you.
4.After it is returned by the court, submit the Court Compliance Statement (form B) to the health professional with the Revocation Certificate (form A) and Substance Abuse Evaluation (form C).
Substance Abuse Evaluation (form C) – alcohol/drug related revocations only
1.This form must be completed by the health professional.
2.Submit all three forms to the health professional conducting the evaluation. The health professional must review the Revocation Certificate (form A) and Court Compliance Statement (form B), and complete the Substance Abuse Evaluation (form C).
3.The health professional must submit the original of all three forms to MVD.
4.You are responsible for any expenses required to complete the substance abuse evaluation.
MVD Review – All forms/information are reviewed, and you will be notified in writing of the final decision.
Health Professional – The substance abuse evaluation must be completed by one or more of the following:
•Substance abuse counselor who is nationally certified by the Arizona Board of Behavioral Health Examiners, Arizona Department of Health Services or by a comparable board in another state
•Substance abuse counselor who is employed by the federal government and who is practicing in this state
•Physician or psychologist who is licensed to practice in this state, or in any other state
•Physician or psychologist who is employed by the federal government and who is practicing in this state
For a list of eligible substance abuse counselors visit the Motor Vehicle Division website under Driver Services
at www.azdot.gov, or refer to a telephone yellow page directory under Counselor or Alcoholism.
REVOCATION CERTIFICATE
All Applicants Must Complete
99-0139A R02/10 www.azdot.gov
A
Applicant Name (first, middle, last, suffix)
Driver License Number
Date of Birth
Street Address
City
State
Zip
Mailing Address (if different from above)
Home Phone
Daytime Message Phone
(
)
Yes
No
Have
you committed any traffic violations in Arizona or in any other state
within the
past
12 months (CONVICTED OR NOT)? If Yes, please explain:
Traffic Violations and Dates
Are you currently employed?
Does your job require you to operate any type of motor vehicle other than on
private property? If Yes, please explain:
Work-Related Motor Vehicle Operation
Have you been through an MVD investigation prior to this investigation?
How many times?
____
Was a substance abuse evaluation done?
Prior Investigations
For Alcohol/Drug Related Revocations Only
Have you completed or are you currently enrolled in any alcohol/drug treatment or education
programs? If Yes, you may attach any supporting documents.
Authorization To Release Information
Counselor, Physician or Psychologist Name
I hereby authorize the counselor, physician or psychologist above to release to the Motor Vehicle Division any information that is pertinent to my ability to safely operate a motor vehicle, and authorize the Motor Vehicle Division to release to the counselor, physician or psychologist any actions taken on my Arizona driving record prior to and after the investigation.
Applicant Signature
Date
Certification (For All Applicants)
I have read the eligibility requirements and instructions for reinstatement and I am currently eligible to submit this packet. I have answered the above questions to the best of my knowledge. I understand that if my driving privilege is reinstated, any pending offenses or traffic violations that subsequently result in conviction may result in my permission to reinstate being rescinded or my driving privilege being revoked again. I further understand that if a check of another state’s records or a computer check with the National Driver Registry indicates a suspension or revocation still in existence, my license may be canceled or revoked.
Notary or MVD Agent Signature
Acknowledged before me this date.
County
Commission Expires
COURT COMPLIANCE
STATEMENT
DUI Alcohol/Drug Related Revocations Only
99-0139B R02/10 www.azdot.gov
Mailing Address
B
I am now eligible for reinstatement of my Arizona driving privileges after a revocation. Please provide the following information to be considered by the Motor Vehicle Division.
This section must be completed in full
by court clerk, Arizona Department of Corrections (ADC) parole or probation officer, or judge.
Court Name (for last DUI alcohol/drug related offense in Arizona)
Complaint Number
Violation Date
Docket Number
Was alcohol screening ordered?
Was alcohol screening completed?
Was treatment recommended or required? If Yes, please explain:
Treatment Type
Was treatment completed?
Were the applicant’s records purged?
Please attach copies of any documentation establishing compliance/non-compliance.
Court Clerk, ADC Parole or Probation Officer, or Judge Signature
Phone
()
[Court Seal]
Return Completed Form To Applicant
DUI-RELATED
SUBSTANCE ABUSE
EVALUATION
99-0139C R02/10 www.azdot.gov
Must be completed in full
by counselor, physician or psychologist.
C
The applicant above is required by state law to have this evaluation completed in order to be considered for reinstatement of driving privileges in Arizona. Your response on this form will indicate to the Motor Vehicle Division how this person’s substance abuse condition may affect or impair his or her ability to safely operate a motor vehicle. For purposes of deciding whether to reinstate the driving privilege, we may rely on your opinion.
History of all DUIs and alcohol/drug related offenses (traffic, criminal and out-of-state), convicted or not.
Offense
Offense Date
Alcohol Level
(required)
Drug Type
(if applicable)
Offense State
(AZ, CA, etc.)
Testing instruments utilized in evaluation (a minimum of two standardized testing instruments are required).
Please specify instrument and scores.
Mortimor-Filkins
SASSI
MAST
DRI
Other (standardized test)
Diagnostic Impressions (DSM IV) – Indicate condition/problem and number of prior contacts. Give facts supporting this diagnosis.
Diagnostic Impressions
Client Alcohol/Drug Abuse History
Length of Current Abstinence
Family Substance Abuse History
Substance Abuse Education/Treatment History (specify programs and dates)
Client support group history (specify period and frequency):
Alcoholics Anonymous (AA)
Sponsor?
YES
NO
Narcotics Anonymous (NA)
Rational Recovery
Support group history was:
Self disclosed (no documentation)
Verified by documentation of attendance
Prognosis/Observations/Factors (include reasons for opinion)
Recommendations (only if opinion affirmatively indicates an affect upon ability to safely operate a motor vehicle)
I acknowledge that I have read the Revocation Certificate (form A) and the Court Compliance Statement (form B) and they are complete.
Initials
Based on my evaluation, it is my opinion that the condition of the Applicant:
Does
Does Not affect his or her ability to safely operate a motor vehicle.
Evaluator Certification
State law requires all persons who seek reinstatement of Arizona driving privileges following an alcohol or drug-related revocation must provide the Motor Vehicle Division with a current substance abuse evaluation from a:
•Substance abuse counselor who is certified nationally, certified by the Arizona Board of Behavioral Health Examiners, or certified by a comparable board in another state; OR
•Substance abuse counselor who is employed by the federal government and who is practicing in this state; OR
•Physician or psychologist who is licensed to practice in this state, or in any other state; OR
•Physician or psychologist who is employed by the federal government and who is practicing in this state.
I certify that I meet one of the above requirements.
Evaluator Name
Title
Program Name (if applicable)
Professional Certification/License Number
Evaluator Signature
The originals of this form, the Revocation Certificate (form A) and the Court Compliance Statement (form B) along with a copy of your professional certification/license must be mailed to the address below, within 30 days of the signature date, and a copy provided to the Applicant.
MAIL DROP 530M
DRIVER IMPROVEMENT UNIT
MOTOR VEHICLE DIVISION
PO BOX 2100
PHOENIX AZ 85001-2100
Completing the Arizona Motor Vehicle Division Packet is essential for those seeking reinstatement of their driving privileges after a revocation. Following the steps outlined below will ensure that all necessary information is submitted correctly and promptly.
The Arizona Motor Vehicle Division Packet form is used to initiate the reinstatement process for individuals whose driving privileges have been revoked due to DUIs or alcohol/drug-related offenses. It ensures that applicants meet specific eligibility criteria before they can have their driving privileges restored.
To be eligible, you must meet several requirements:
If your revocation is related to alcohol or drugs, you need to complete three forms:
All three forms should be submitted together to the Motor Vehicle Division.
If you submit an incomplete packet, it will be returned to you. It is crucial to follow all instructions carefully and provide complete answers to avoid delays in your reinstatement process.
The Substance Abuse Evaluation must be completed by a qualified health professional. This includes:
Ensure that the professional you choose is recognized and meets the requirements set by the Motor Vehicle Division.
Once you submit your completed forms, the Motor Vehicle Division will review all information provided. You will receive a written notification regarding the final decision on your reinstatement. It is important to keep your contact information updated to ensure you receive this notification promptly.
Failing to Call for Eligibility Confirmation: Before submitting the packet, individuals often forget to call the appropriate number to confirm their eligibility for reinstatement. This step is crucial and can save time and effort.
Submitting After 30 Days: Many applicants make the mistake of submitting the packet more than 30 days after it has been signed by a health professional. This can lead to automatic rejection of the application.
Incomplete Information on Form C: Some people neglect to list all DUIs and alcohol/drug-related offenses on form C. This includes offenses from other states, whether convicted or not. Omitting this information can result in delays or denials.
Ignoring Instructions: It is common for applicants to overlook specific instructions provided in the packet. Each detail matters, and failing to follow them can lead to the packet being returned.
Not Providing Complete Answers: Leaving spaces blank on any form is a frequent error. All questions must be answered fully to avoid complications in the review process.
Neglecting Court Compliance Documentation: For alcohol/drug-related revocations, applicants sometimes fail to submit the Court Compliance Statement. This document is essential for the process and must be returned from the court before submission.
Forgetting to Sign Before a Notary: Applicants often forget to sign and date the certification statement before a notary public. This step is mandatory and missing it can invalidate the entire packet.
The Arizona Motor Vehicle Division Packet is an important set of documents for individuals seeking to reinstate their driving privileges after a revocation. Along with this packet, several other forms and documents are often required. Below is a list of these essential documents, each accompanied by a brief description.
Gathering these documents is crucial for a smooth reinstatement process. Each form plays a significant role in ensuring that the Motor Vehicle Division can make an informed decision regarding the applicant's eligibility to drive again. Proper preparation can save time and reduce the likelihood of complications during the reinstatement process.
The Arizona Motor Vehicle Division Packet form bears similarities to the Driver's License Application form, which is a standard document used when individuals seek to obtain a driver's license for the first time. Both forms require personal information such as the applicant's name, date of birth, and address. Additionally, both documents necessitate the disclosure of any prior traffic violations or legal issues that may affect the applicant's eligibility to drive. While the Driver's License Application focuses on initial qualifications, the MVD Packet emphasizes reinstatement after revocation, showcasing a critical distinction in purpose.
Another document that aligns closely with the Arizona Motor Vehicle Division Packet is the SR-22 form, which serves as proof of financial responsibility for high-risk drivers. Like the MVD Packet, the SR-22 form requires detailed personal information and can be a prerequisite for reinstatement of driving privileges. Both documents aim to ensure that individuals meet specific legal requirements before they can legally operate a vehicle. The SR-22 form, however, is more focused on insurance coverage, while the MVD Packet encompasses broader eligibility criteria related to driving history.
The Court Compliance Statement is also similar to the MVD Packet, particularly for those facing alcohol or drug-related revocations. This document requires individuals to confirm their compliance with court mandates, similar to the MVD Packet's emphasis on meeting eligibility requirements for reinstatement. Both forms necessitate the submission of relevant information to demonstrate that the applicant has resolved any outstanding legal issues. The Court Compliance Statement, however, is specifically tied to court-ordered actions, while the MVD Packet encompasses a wider range of conditions for reinstatement.
The Substance Abuse Evaluation form shares a connection with the MVD Packet, particularly in cases involving alcohol or drug-related offenses. Both documents require a comprehensive assessment by a qualified health professional to determine the applicant's ability to drive safely. The Substance Abuse Evaluation focuses on the individual's substance use history and its impact on driving capabilities, while the MVD Packet integrates this evaluation into the broader context of reinstatement eligibility. This highlights the importance of health assessments in the driving reinstatement process.
Additionally, the Vehicle Registration Application can be compared to the MVD Packet, as both require applicants to provide personal and vehicle-related information. While the Vehicle Registration Application is primarily concerned with the ownership and registration of a vehicle, the MVD Packet deals with the reinstatement of driving privileges after revocation. Both documents, however, serve to ensure that individuals are in compliance with state regulations, reflecting a shared goal of promoting responsible vehicle operation.
Finally, the Traffic Violation Ticket serves as a relevant comparison to the MVD Packet. Both documents address the consequences of traffic violations and the necessary steps for individuals to rectify their driving status. The Traffic Violation Ticket outlines penalties and required actions following a violation, while the MVD Packet details the process for reinstatement after revocation. Each document emphasizes the importance of adhering to traffic laws and the implications of failing to do so, reinforcing the need for accountability among drivers.
When filling out the Arizona Motor Vehicle Division Packet form, it is essential to follow certain guidelines to ensure a smooth process. Here are five things you should and shouldn't do:
Misconceptions about the Arizona Motor Vehicle Division Packet form can lead to confusion and delays in the reinstatement process. Below are five common misconceptions along with clarifications.
This is incorrect. You must submit the packet within 30 days of the date it was signed by a health professional. Failing to adhere to this timeline may result in the packet being returned.
In reality, certain forms require additional documentation. For instance, if your revocation is alcohol or drug-related, you must submit the Revocation Certificate along with the Court Compliance Statement and Substance Abuse Evaluation.
Contrary to this belief, you are required to list all DUIs and alcohol or drug-related offenses, whether convicted or not. Omitting this information can lead to complications in the review process.
This is misleading. The health professional must review the Revocation Certificate and Court Compliance Statement before completing the Substance Abuse Evaluation. This ensures that all relevant information is considered.
This is not the case. The Motor Vehicle Division will review all submitted forms and information. You will be notified in writing of the final decision, which may take time.
When filling out and using the Arizona Motor Vehicle Division Packet form, keep the following key takeaways in mind: