The Arizona Motor Vehicle Division Packet form is a crucial document for individuals seeking reinstatement of their driving privileges after a revocation. This form includes several components that must be completed accurately, including a revocation certificate, court compliance statement, and substance abuse evaluation. Understanding the requirements and following the instructions carefully can significantly impact the reinstatement process.
When filling out the Arizona Motor Vehicle Division Packet form, it is crucial to follow specific guidelines to ensure a smooth application process. Here are nine essential do's and don'ts:
Filling out the Arizona Motor Vehicle Division Packet form can seem daunting, but understanding key points can simplify the process. Here are some important takeaways to keep in mind:
By keeping these takeaways in mind, you can navigate the process more effectively and increase your chances of a successful reinstatement of your driving privileges in Arizona.
The Arizona Motor Vehicle Division Packet form is used for individuals seeking reinstatement of their driving privileges after a revocation, particularly due to alcohol or drug-related offenses. It consists of several forms that must be completed and submitted to demonstrate eligibility for reinstatement. This packet ensures that all necessary evaluations and compliance documents are provided to the Motor Vehicle Division (MVD) for review.
Before submitting the packet, you must meet specific eligibility criteria:
Meeting these requirements is crucial for your application to be accepted.
To complete the packet, you will need several forms:
All forms must be completed accurately and submitted as per the instructions to avoid delays or rejection of your application.
Once you submit your completed packet, the MVD will review all forms and information. You will receive a written notification regarding the final decision. This process ensures that all aspects of your application are considered before reinstatement is granted. If your application is denied, the notification will typically include the reasons for the denial and any steps you can take to rectify the situation.
When working with the Arizona Motor Vehicle Division Packet form, several other forms and documents may be needed to complete the reinstatement process. Each of these documents serves a specific purpose and is crucial for ensuring a smooth application. Below is a list of these forms along with a brief description of each.
Gathering these documents promptly can help expedite the reinstatement process. Ensure that all forms are completed accurately and submitted within the required time frames. This will aid in a smoother experience with the Arizona Motor Vehicle Division.
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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
Filling out the Arizona Motor Vehicle Division Packet form can seem overwhelming, but breaking it down into clear steps makes it manageable. After gathering the necessary information and forms, you will be ready to submit your packet for review. Follow the steps below to ensure that you complete the form correctly and efficiently.
Filling out the Arizona Motor Vehicle Division Packet form can be a daunting task. Many applicants make common mistakes that can delay their reinstatement process. One significant error is not calling the designated numbers before submission. It’s essential to confirm eligibility for reinstatement before mailing the packet. Failure to do so can result in wasted time and effort.
Another frequent mistake is submitting the packet more than 30 days after it has been signed by a health professional. This deadline is crucial. If you miss it, your application will be rejected, and you’ll need to start over. Always check the date to ensure compliance.
In addition, applicants often leave spaces blank on form C. It is critical to provide complete answers to all questions. Leaving any part of the form unanswered can lead to the entire packet being returned. Make sure to double-check that every question is filled out completely.
Many individuals also overlook the requirement to list all DUIs and alcohol/drug-related offenses. This includes both traffic and criminal offenses, regardless of conviction status. Omitting this information can be seen as an attempt to hide details, which could jeopardize your reinstatement.
Another mistake involves not obtaining the necessary documents from the court regarding any previous judgments. If your driving privilege was suspended due to a court judgment, you must provide proof that it has been satisfied. Without this documentation, the packet cannot be processed.
Finally, some applicants fail to resolve any outstanding warrants or pending traffic complaints before submitting their packets. It is vital to address these issues first. The Motor Vehicle Division will not accept your application until all court-mandated requirements are fulfilled. Always ensure that you have no unresolved legal matters before sending in your packet.