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California > Judicial Council > Ignition Interlock Device

Ignition Interlock Noncompliance Report ID-130 - California

Ignition Interlock Noncompliance Report Form. This is a California form and can be used in Ignition Interlock Device Judicial Council .
 Fillable pdf Last Modified 10/8/2001
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ID-130 NAME AND ADDRESS OF COURT: FOR COURT USE ONLY NAME OF DEFENDANT: STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: HOME TELEPHONE NO.: WORK TELEPHONE NO.: DRIVER'S LICENSE NO.: CASE NUMBER: IGNITION INTERLOCK NONCOMPLIANCE REPORT 1. The above-named defendant has failed to make or keep an appointment for of the ignition interlock device(s) in the vehicle(s) checked below. Make a. b. c. Model Year Color installing monitoring License Plate No. and/or V.l.N. 2. The ignition interlock device installed in the vehicle(s) checked below showed evidence of tampering attempt(s) to remove Make a. b. c. Model Year Color attempt(s) to bypass License Plate No. and or V.I.N. 3. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: ................................. (TYPE OR PRINT NAME) (SIGNATURE OF FACILITY MONITOR) Name of facility monitor (specify): Name of facility (specify): Address of facility (specify): Telephone number of facility (specify): Form Approved for Optional Use Judicial Council of California ID-130 [Rev. January 1, 2000] IGNITION INTERLOCK NONCOMPLIANCE REPORT (Ignition Interlock Device) Vehicle Code, §§ 23575, 23576 2001 © American LegalNet, Inc.
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