The Arizona Motor Vehicle Division Packet form is a crucial document for individuals seeking to reinstate their driving privileges after a revocation. This packet includes several forms that must be completed accurately and submitted to the Motor Vehicle Division (MVD) to assess eligibility for reinstatement. To begin the process, click the button below to fill out the necessary forms.
The Arizona Motor Vehicle Division (MVD) Packet form is a crucial document for individuals seeking to reinstate their driving privileges after a revocation, particularly due to alcohol or drug-related offenses. This packet includes several forms, each serving a specific purpose in the reinstatement process. The Revocation Certificate (form A) requires applicants to provide personal information and disclose any traffic violations within the past year. For those with alcohol or drug-related revocations, the Court Compliance Statement (form B) must be completed by the court where the last DUI conviction occurred, confirming compliance with court orders. Additionally, the Substance Abuse Evaluation (form C) must be filled out by a qualified health professional, assessing the individual's ability to safely operate a vehicle. Each form comes with detailed instructions, emphasizing the importance of accuracy and completeness to avoid delays. Furthermore, eligibility requirements must be met prior to submission, including the completion of any court-mandated actions and the passage of time since any recent traffic violations. Applicants are advised to contact the MVD before submitting the packet to confirm their eligibility for reinstatement. Failure to adhere to these guidelines can result in the return of incomplete packets, complicating the reinstatement process. Understanding these components is essential for anyone navigating the complexities of the Arizona driving reinstatement system.
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
Completing the Arizona Motor Vehicle Division Packet form is a crucial step in the process of reinstating your driving privileges. Ensure that you follow the steps carefully to avoid any delays. The information you provide will be reviewed, and you will receive a notification regarding the outcome of your application.
What is the purpose of the Arizona Motor Vehicle Division Packet form?
The Arizona Motor Vehicle Division Packet form is designed for individuals seeking to reinstate their driving privileges after a revocation. It includes necessary documents and instructions for completing the reinstatement process. The packet ensures that all relevant information regarding past offenses, compliance with court orders, and substance abuse evaluations is submitted for review.
How do I determine my eligibility for reinstatement?
To determine your eligibility, you should first contact the appropriate Motor Vehicle Division office. This can be done by calling 602-255-0072 if you are in Phoenix, 520-629-9808 in Tucson, or 800-251-5866 elsewhere in Arizona. You must also meet specific criteria, including the completion of your revocation period and the resolution of any outstanding warrants or traffic violations.
What forms do I need to complete for alcohol or drug-related revocations?
If your revocation is related to alcohol or drugs, you will need to complete three forms: the Revocation Certificate (form A), the Court Compliance Statement (form B), and the Substance Abuse Evaluation (form C). These forms must be filled out accurately and submitted together to the Motor Vehicle Division after being reviewed by a qualified health professional.
What happens if I submit an incomplete packet?
Submitting an incomplete packet will result in its return to you. It is essential to follow all instructions carefully and ensure that all required information is provided. Incomplete submissions can delay your reinstatement process significantly.
What should I do if I have traffic violations within the past 12 months?
If you have committed any traffic violations within the past 12 months, you must wait until 12 months have passed since the date of those violations before your application for reinstatement can be accepted by the Motor Vehicle Division. This waiting period is a critical eligibility requirement.
Who can conduct the Substance Abuse Evaluation?
The Substance Abuse Evaluation must be completed by a qualified health professional. Acceptable professionals include substance abuse counselors certified by the Arizona Board of Behavioral Health Examiners, licensed physicians or psychologists, or federal government employees practicing in Arizona. It is your responsibility to ensure that the evaluation is conducted by an eligible provider.
Where do I send the completed packet?
Once you have completed all required forms, you should send the packet to the following address: Mail Drop 530M, Driver Improvement Unit, Motor Vehicle Division, PO Box 2100, Phoenix, AZ 85001-2100. Ensure that all forms are included and that they are filled out correctly before mailing to avoid delays.
Filling out the Arizona Motor Vehicle Division Packet form can be a straightforward process, but many people make common mistakes that can delay their reinstatement. One of the most frequent errors is failing to call the appropriate numbers before submitting the packet. It’s essential to check your eligibility for reinstatement first. Ignoring this step can lead to wasted time and effort, as you may discover that you are not yet eligible.
Another common mistake is submitting the packet more than 30 days after it has been signed by a health professional. This is a strict timeline that must be adhered to. If you miss this window, your packet will be returned, and you will have to start the process over again. Keeping track of dates is crucial.
People often overlook the requirement to list all DUIs and alcohol or drug-related offenses on form C. This includes offenses from other states, regardless of whether they resulted in a conviction. Omitting this information can lead to complications and potential rejection of your application.
Many applicants leave spaces blank on the forms, which can result in an incomplete packet. Every question must be answered fully. If you skip questions, the packet will be returned, and you will have to resubmit it. Attention to detail is vital when filling out these forms.
Another mistake involves misunderstanding the requirements for the Court Compliance Statement (form B). This form is only necessary for alcohol or drug-related revocations. Submitting it when it is not required can cause confusion and delay. Ensure you know which forms apply to your specific situation.
Some individuals also fail to resolve any outstanding warrants or pending traffic violations before submitting their packet. This is a critical step. If there are unresolved issues, the packet will not be accepted. You must clear any legal hurdles before proceeding with your application.
Lastly, neglecting to have your forms notarized or signed by the appropriate individuals can lead to rejection. The certification statement must be signed and dated before a notary public or MVD agent. This step is often overlooked, but it is essential for the validity of your submission. Make sure all signatures are in place before mailing your packet.
The Arizona Motor Vehicle Division Packet is essential for individuals seeking reinstatement of their driving privileges after a revocation. Along with this packet, several other forms and documents may be required to ensure a smooth process. Each of these documents serves a specific purpose and must be completed accurately to avoid delays. Below is a list of commonly used forms that accompany the Arizona Motor Vehicle Division Packet.
Completing these forms accurately and submitting them along with the Arizona Motor Vehicle Division Packet is crucial for a successful reinstatement of your driving privileges. Ensure all required documents are submitted to avoid unnecessary delays in the process.
The Arizona Motor Vehicle Division Packet form shares similarities with several other important documents related to driving privileges and legal compliance. Here’s a list of those documents and how they relate to the Arizona Motor Vehicle Division Packet form:
When filling out the Arizona Motor Vehicle Division Packet form, it is important to follow specific guidelines to ensure the process goes smoothly. Below is a list of things you should and shouldn't do:
Many people believe they can submit the packet whenever they feel ready. However, it’s crucial to submit it within 30 days of the date it was signed by a health professional. Failing to do so could lead to delays in your reinstatement process.
Some individuals think they can leave sections blank if they don't apply to them. This is incorrect. Incomplete packets will be returned, which can prolong the reinstatement process. Make sure every question is answered completely.
It's a common belief that only local offenses need to be reported. In reality, you must list all DUIs and alcohol/drug-related offenses, regardless of where they occurred. This includes traffic and criminal offenses from other states.
Some applicants think they can submit their packet without resolving any pending traffic violations. This is not the case. You must first resolve all court-mandated requirements and obtain written satisfaction from the court before submitting your packet.
Many believe that the evaluation by a health professional is not mandatory. However, for alcohol or drug-related revocations, this evaluation is a required part of the reinstatement process. Ensure you have the necessary evaluations completed to avoid complications.
Contact Information: Before submitting the packet, call to check your eligibility for reinstatement. Use the appropriate numbers based on your location in Arizona.
Submission Deadline: Ensure you submit the packet within 30 days after it has been signed by a health professional.
Disclosure of Offenses: On form C, list all DUIs and alcohol/drug-related offenses, regardless of conviction status.
Completeness is Key: Follow all instructions carefully. Any incomplete packets will be returned, delaying your reinstatement process.
Eligibility Criteria: Confirm that you meet all eligibility requirements before submitting the packet, including the completion of any necessary court-mandated actions.
Health Professional Requirements: The substance abuse evaluation must be conducted by a qualified health professional. Ensure they complete and submit all required forms to the Motor Vehicle Division.