Name is/are inoperable. PRINT NAME I certify that all information given on this statement is true and correct. WARNING: SIGNATURE IN INK DATE Misstatement of facts is a misdemeanor of the third degree punishable by fine of up to $2,500.00 and/or imprisonment up to one year (18 Pa. C.S. Section 4904(b)) SEE BACK OF THIS FORM FOR INSTRUCTIONS CUSTOMER INSTRUCTIONS FOR COMPLETING THIS FORM This form is to be comple.
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How to fill out the DL-21SC (5-17) online
The DL-21SC (5-17) form is crucial for users seeking to certify vehicle ownership or operation while applying for ignition interlock device installation. This guide provides comprehensive steps to assist you in accurately completing the form online to ensure your submission is complete and correct.
Follow the steps to fill out the DL-21SC (5-17) form online.
- Click ‘Get Form’ button to obtain the DL-21SC (5-17) and open it in the online editor.
- In Section A, provide your full driver information. Enter your name, address, driver license number, city, state, and zip code. Ensure accuracy in these details to avoid any processing issues.
- Proceed to Section B to list all vehicles you own or are permitted to operate. For each vehicle, include the plate number, title number, VIN number, and year/make. If a violation occurred prior to October 1, 2003, you can check the appropriate box and omit vehicle details.
- In Section C, indicate your ownership status by checking the appropriate box. If you have vehicles inoperable, or if your income qualifies for a hardship exemption, ensure to follow the accompanying instructions for that section. Print and sign your name and date it at the end of this section.
- Finally, after you have filled out Section C, follow the vendor's instructions to complete Section D. This section requires verification by the vendor who will confirm the details and sign off on the installation of the ignition interlock device. Make sure the vendor completes their part before submission.
- Once all sections are filled out and verified, you may save your changes, download, print, or share the completed form as needed before emailing the final document to RA-PDIGNINTSELFCERTS@pa.gov.
Complete your DL-21SC (5-17) form online today to ensure a smooth restoration process.
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Get answers to your most pressing questions about US Legal Forms API.
How long do you have to have ignition interlock in PA?
An individual will be required to drive with the ignition interlock system for one year from date of restoration. However, if the person is convicted of a 3808(a) or 3808(b) violation and it's their first offense their ignition interlock period will be extended 1 year from the date of conviction.
What does DL 21 sent to PennDOT mean?
What is DL 21s sent to PennDOT? DL-21 refers to a Form. It is the form the clerk of a court of record of Pennsylvania sends to the Department of transportation regarding judgment of conviction, acquittal or other disposition of charges under 75 Pa.
Who is eligible for ignition interlock in PA?
An Ignition Interlock Limited License is a driver's license issued to an individual whose operating privilege is suspended or revoked for one or more violations of driving under the influence of alcohol or a controlled substance or refusal to submit to chemical testing.
How much is a permit in PA?
The Pennsylvania learner's permit is your first step towards being a fully licensed driver. To get a permit, you'll need to pass a written knowledge test, vision test, and pay a $35.50 fee at your local PennDOT Driver License Center.
Who is eligible for ignition interlock limited license in PA?
An Ignition Interlock Limited License is a driver's license issued to an individual whose operating privilege is suspended or revoked for one or more violations of driving under the influence of alcohol or a controlled substance or refusal to submit to chemical testing.
How do I get an interlock in PA?
To apply, an individual must complete an Ignition Interlock Limited License Petition, PennDOT form DL-9108, which includes a DL-9108SC form, and send it with the required fees and documentation to PennDOT by certified mail to the address listed on the petition.
What is the new PA interlock law?
Pennsylvania law makes the Ignition Interlock requirement mandatory for first-time DUI offenders with high blood alcohol levels, repeat DUI offenders, individuals who refuse chemical testing, and for illegally operating a motor vehicle not equipped with an Ignition Interlock system.
How much does interlock cost in PA?
The monthly cost of an ignition interlock device (also known as a car breathalyzer or ignition interlock system) in Pennsylvania is $75-$105. The overall cost of an IID in Pennsylvania will depend on various factors, including: Length of time you need the interlock device.
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