Form P-246 "Ignition Interlock Device - Installation Application" - Connecticut

What Is Form P-246?

This is a legal form that was released by the Connecticut Department of Motor Vehicles - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2018;
  • The latest edition provided by the Connecticut Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form P-246 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Motor Vehicles.

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Download Form P-246 "Ignition Interlock Device - Installation Application" - Connecticut

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IGNITION INTERLOCK DEVICE
INSTALLATION APPLICATION
P-246 Rev. 2-2018
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
DRIVER SERVICES DIVISION
60 State Street, Wethersfield, CT 06161-1013
TELEPHONE: (860) 263-5720
INSTRUCTIONS (Please print or type):
1.
Complete Part 1 of this form and sign the Operator Certification. If you are not the owner of record for the vehicle
listed, the registered owner must complete and sign Part 2.
2.
Contact one of the Connecticut approved vendors to schedule an appointment to install the Ignition Interlock
Device (IID). The installer must complete and sign Part 3. Submit the completed form to the address above.
3.
The vehicle listed on this form must have a valid registration. If the vehicle is registered outside Connecticut, you
must submit a copy of the registration certificate.
4.
Pay the $175.00 restoration fee and the $100.00 IID Administration fee. You may pay the fees online at ct.gov/dmv
or by a check or money order made payable to DMV and mailed to the above address.
5.
Vendor information and additional forms can be found at ct.gov/dmv
6.
Your IID requirement starts from the date of restoration not installation.
PART 1 - OPERATOR/VEHICLE INFORMATION
APPLICANT'S NAME (As it appears on your operator's license)
(Last)
(First)
(Middle)
DATE OF BIRTH
MAILING ADDRESS
(Number and Street)
(City or Town)
(State)
(Zip Code)
TELEPHONE
E-MAIL
VEHICLE IDENTIFICATION NUMBER (VIN)
LICENSING STATE
OPERATOR LICENSE NUMBER
MAKE
REG. PLATE #
STATE
YEAR
FOR CHANGES TO EXISTING IID RECORDS CHECK ALL THAT APPLY
ADDITIONAL VEHICLE WITH IID
MOVING IID FROM ANOTHER VEHICLE
CHANGING IID VENDOR
OPERATOR CERTIFICATION
Following approval by the Department of Motor Vehicles, I understand that I must have an Ignition Interlock Device (IID) in each vehicle that I own or
operate during the entire time that I am subject to an IID restriction, and that such device must be maintained and calibrated in accordance with DMV
regulations.
The statements and information provided to the Commissioner of Motor Vehicles herein are subscribed by me, the undersigned, under penalty of false
statement, in accordance with the provisions of Sections 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if I make a
statement herein which I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution.
SIGNATURE
DATE SIGNED
X
PART 2 - OWNER INFORMATION/AUTHORIZATION
VEHICLE OWNER
ADDRESS
CITY
STATE
ZIP CODE
I swear or affirm under penalty of false statement in accordance with Connecticut General Statutes §14-110 and §53a-157, and subject to penalties for
perjury for a deliberate false statement, that the above information and any attachment is true and correct.
PRINTED NAME OF OWNER
SIGNATURE OF OWNER
DATE SIGNED
X
PART 3 - INSTALLER
IID TYPE
IID MODEL
IID SERIAL #
IID VENDOR
INSTALLED AT (Printed Business Name and Address):
TELEPHONE
The statements and information provided to the Commissioner of Motor Vehicles herein are subscribed by me, the undersigned, under penalty of
false statement, in accordance with the provisions of Sections 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if I make
a statement herein which I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution.
SIGNATURE OF INSTALLER
DATE SIGNED
PRINTED NAME OF INSTALLER ( Last, First, Middle)
X
DO NOT OPERATE A MOTOR VEHICLE UNTIL YOU RECEIVE CONFIRMATION
THAT YOU ARE RESTORED AND HAVE A VALID LICENSE.
ALLOW 10 BUSINESS DAYS FOR PROCESSING
IGNITION INTERLOCK DEVICE
INSTALLATION APPLICATION
P-246 Rev. 2-2018
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
DRIVER SERVICES DIVISION
60 State Street, Wethersfield, CT 06161-1013
TELEPHONE: (860) 263-5720
INSTRUCTIONS (Please print or type):
1.
Complete Part 1 of this form and sign the Operator Certification. If you are not the owner of record for the vehicle
listed, the registered owner must complete and sign Part 2.
2.
Contact one of the Connecticut approved vendors to schedule an appointment to install the Ignition Interlock
Device (IID). The installer must complete and sign Part 3. Submit the completed form to the address above.
3.
The vehicle listed on this form must have a valid registration. If the vehicle is registered outside Connecticut, you
must submit a copy of the registration certificate.
4.
Pay the $175.00 restoration fee and the $100.00 IID Administration fee. You may pay the fees online at ct.gov/dmv
or by a check or money order made payable to DMV and mailed to the above address.
5.
Vendor information and additional forms can be found at ct.gov/dmv
6.
Your IID requirement starts from the date of restoration not installation.
PART 1 - OPERATOR/VEHICLE INFORMATION
APPLICANT'S NAME (As it appears on your operator's license)
(Last)
(First)
(Middle)
DATE OF BIRTH
MAILING ADDRESS
(Number and Street)
(City or Town)
(State)
(Zip Code)
TELEPHONE
E-MAIL
VEHICLE IDENTIFICATION NUMBER (VIN)
LICENSING STATE
OPERATOR LICENSE NUMBER
MAKE
REG. PLATE #
STATE
YEAR
FOR CHANGES TO EXISTING IID RECORDS CHECK ALL THAT APPLY
ADDITIONAL VEHICLE WITH IID
MOVING IID FROM ANOTHER VEHICLE
CHANGING IID VENDOR
OPERATOR CERTIFICATION
Following approval by the Department of Motor Vehicles, I understand that I must have an Ignition Interlock Device (IID) in each vehicle that I own or
operate during the entire time that I am subject to an IID restriction, and that such device must be maintained and calibrated in accordance with DMV
regulations.
The statements and information provided to the Commissioner of Motor Vehicles herein are subscribed by me, the undersigned, under penalty of false
statement, in accordance with the provisions of Sections 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if I make a
statement herein which I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution.
SIGNATURE
DATE SIGNED
X
PART 2 - OWNER INFORMATION/AUTHORIZATION
VEHICLE OWNER
ADDRESS
CITY
STATE
ZIP CODE
I swear or affirm under penalty of false statement in accordance with Connecticut General Statutes §14-110 and §53a-157, and subject to penalties for
perjury for a deliberate false statement, that the above information and any attachment is true and correct.
PRINTED NAME OF OWNER
SIGNATURE OF OWNER
DATE SIGNED
X
PART 3 - INSTALLER
IID TYPE
IID MODEL
IID SERIAL #
IID VENDOR
INSTALLED AT (Printed Business Name and Address):
TELEPHONE
The statements and information provided to the Commissioner of Motor Vehicles herein are subscribed by me, the undersigned, under penalty of
false statement, in accordance with the provisions of Sections 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if I make
a statement herein which I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution.
SIGNATURE OF INSTALLER
DATE SIGNED
PRINTED NAME OF INSTALLER ( Last, First, Middle)
X
DO NOT OPERATE A MOTOR VEHICLE UNTIL YOU RECEIVE CONFIRMATION
THAT YOU ARE RESTORED AND HAVE A VALID LICENSE.
ALLOW 10 BUSINESS DAYS FOR PROCESSING