Get AZ DoT 99-0139 2010
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 profession.
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