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Get KY AOC-492.A 2020-2024

A Doc. Code AFHD Rev. 5-16 Page 1 of 2 Commonwealth of Kentucky Court of Justice www. courts. ky. gov OF JUS TI Affidavit For Hardship License COMMONWEALTH OF KENTUCKY PLAINTIFF VS. The undersigned Affiant is the employer/self employed educator physician or ADE program director for the above-named Defendant. UCKY O COMM EA L TH OF KE NT KRS 189A. 400-. 460 NW lex et justitia RT Case No* Court County Division C U E CO AOC- 492. Pursuant to KRS 189A. 410 see page 2 the undersigned states under oath that the above-named Defendant should be granted a hardship driver s license for the reason s stated below including the specific days and times when the Defendant is required to drive. If Employer/self-employed please provide the following information Affiant s Business/Employer s name and address Affiant s title Affiant s phone number on page 2. Driving is necessary on the following days and at these specified times From To Mon* Tues. Wed* Thurs. Fri. Sat. Sun* WHEREFORE Affiant prays that the above-named Defendant s Application for Hardship Driver s License be granted* NOTICE Pursuant to KRS 189A. 440 3 knowingly assisting Defendant in making a false application statement is a Class A Misdemeanor and results in revocation of the person s operator s license for six 6 months. Affiant s Name Please Print Affiant s Signature Subscribed and sworn to before me by the Affiant this day of 2. My commission expires 2. Notary Public Affiant s Business/Employer s Name Affiant s Title Affiant s Phone INFORMATION REQUIRED PURSUANT TO KRS 189A. 410 FOR ISSUANCE OF HARDSHIP LICENSE If the license is sought for employment purposes A written sworn statement from your employer detailing your job hours of employment and the necessity for you to use a motor vehicle either in work at the direction of your employer during work hours or in travel to and from work. If you are self-employed provide the described information together with a sworn and notarized statement attesting to the truth of the above information* educational institution that you attend containing your class schedule courses being taken and necessity for you to use a motor vehicle in travel to and from school or other educational institution* A license for educational purposes shall not include participation in sports social extracurricular fraternal or other noneducational activities. medical professional licensed but not certified under Kentucky laws attesting to your normal hours of treatment and the necessity to use a motor vehicle to travel to and from the treatment. sworn statement from the director of any alcohol or substance abuse education or treatment program as to the hours in which you are expected to participate in the program the nature of the program and the necessity for you to use a motor vehicle to travel to and from the program* relating to treatment participation in driver improvement programs or other terms and conditions ordered by the court relating to you which require you to use a motor vehicle in traveling to and from the court-ordered program* The court order must include the necessity for use of a motor vehicle.

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