Ignitio

on Interrlock R
Removall Form

Seee instructionss on reverse

Secttion 1: Clie
ent Informa
ation

completed by Sm
mart Start techn ician at time of f installation (please print)

First N
Name:
Date o
of Birth:

MI:

LLast Name:

Install Datee:

Countty:

Causee#:

Condiition of: Bond/Baiil P

Probation Occ. Liceense P
Parole Other:

Secttion 2: Cou
urt Informa
ation

completed by Jud
dge, P.O. or otheer monitoring au
uthority (pleasee print)

F
Fax comple
eted form to
o Smart Sta
art at (972)) 9296638
8, ATTN: Administrattive Departtment
Date:

Phone:

Fax:

Phone and ffax number of authorizing person uused by Smart Staart to validate rem
moval. Do not leavve blank!

Remo
oval Authorized
d by: P.O. Court Officcer Judge Oth
her:
Signature:

Namee:

Print name off person authoriziing removal

Courtt#:

Date Remov
val is OK: (cannnot be removed bbefore this date)

Reaso
on for Removal:: Term Comp
pleted Vehicle In
noperable Veh
hicle Sold
Other: test

Secttion 3: Sma
art Start Va
alidation

must be com
mpleted BEFORE
E removal

Smarrt Start Corp EE:

Namee:

Amount:
A

Datee:

Secttion 4: Serv
vice Centerr Informatiion

compleeted by Smart Sttart technician aat time of removal

Unit Serial#:

Date R
Removed:

Technician:
T

Servicce Location:

Log Downloade
L
d: Yes No (explain):

Paym
ment Amount: $

Payment Type:
P
(cashh, Visa/MC, cashieer's check)

Removal Form Instructions

Print all information when completing the form.
Section 1: Client Information
The Smart Start technician will complete this section at time of installation.

Section 2: Court Information
The person authorizing removal must complete this section. Removals can only be authorized by the appropriate
Judge, Probation Officer, or monitoring authority.
Without a clear name and phone number to ensure authenticity of the order, the form is NOT VALID.
Your attorney cannot authorize the removal of the interlock device.
The date removal is OK is the date the court will allow the device to be removed.

Section 3: Smart Start Validation

This section will be completed by a member of Smart Start's Administrative Department.

Section 4: Service Center Information

This section will be completed by the Smart Start Technician at time of removal.

How to get Authorization for Removal if you were installed as a condition of:

Bond. You were ordered to have the device installed in your vehicle as a condition of your bond until your court hearing. Be
sure to take this form to your court appearance. If the Judge dismisses your case, finds you not guilty, or allows the device to
be removed, the court will complete Section 2 of this form or provide you with a similar form to bring to Smart Start. Only the
Judge can authorize a removal.
Probation: You were ordered to have the device installed in your vehicle as a condition of your probation. You can be
removed when you complete your term. Be sure Smart Start has a copy of your probation papers prior to completing your
term. Early removal can only be authorized by the Judge who ordered the device. When you have modified terms that do not
require the device, or you receive an early release from probation, your probation officer or judge will give you a letter stating
that fact. This letter will act as your authorization for removal.
Occupational License / Automatic License Revocation: You were ordered to have the device installed in your vehicle as a
condition of obtaining an occupational license. You must supply Smart Start with a copy of this order indicating the term of
your requirement for an ignition interlock device. You can be removed when you complete your term. Only the Judge can
authorize an early removal.

STOLEN OR PERMANENTLY INOPERABLE VEHICLE: Any claims of a stolen device or vehicle must be accompanied by a
WRITTEN POLICE REPORT. This is NOT AUTHORIZATION FOR REMOVAL. You must provide a copy of this report to both Smart Start and
your Probation Officer or Judge and then follow the appropriate steps above. Unless you are released from the requirement for the device,
you must have another unit installed. You are responsible for the return of the stolen unit to Smart Start or the replacement cost of $650. If
your vehicle is permanently inoperable you will need to get permission from the appropriate monitoring authority for removal. Until then,
you will be required to pay monthly lease payments for the device.
FAILURE TO COMPLY WITH THE TERMS OF YOUR LEASE AGREEMENT OR YOUR COURT ORDER: Should you fail
to comply with the terms of either your Smart Start Lease Agreement or your Court Order, Smart Start will reclaim its property. This
unauthorized removal will be reported to the appropriate judge, probation, bond or other monitoring authority as a VIOLATION and NON
COMPLIANCE with the program. This could result in the revocation of your probation, occupational license or bond and may lead to your
arrest.