Form MC393 "Certification to Department of State (Interlock Program)" - Michigan

This version of the form is not currently in use and is provided for reference only.
Download this version of Form MC393 for the current year.

What Is Form MC393?

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

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the Michigan Courts;
  • 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 MC393 by clicking the link below or browse more documents and templates provided by the Michigan Courts.

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Download Form MC393 "Certification to Department of State (Interlock Program)" - Michigan

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Original - Court
Approved, SCAO
1st copy - Department of State
STATE OF MICHIGAN
CASE NO.
JUDICIAL DISTRICT
CERTIFICATION TO DEPARTMENT OF STATE
JUDICIAL CIRCUIT
(INTERLOCK PROGRAM)
Court address
Court telephone no.
Defendant’s name, address, and telephone no.
The State of Michigan
v
THE PEOPLE OF
DLN
DOB
TO: Department of State
1. The defendant has been admitted into the DWI/sobriety court program; and an approved, certified ignition interlock device
has been installed in each motor vehicle owned or operated, or both, by the defendant as required under MCL 257.625k
and MCL 257.625l.
2. Travel
is
is not
allowed under MCL 257.304(4)(b)(xi).
3. The defendant has successfully completed the DWI/sobriety court program.
4. Under MCL 600.1084(6), the Secretary of State is informed that:
a. the court ordered that the defendant be removed from the DWI/sobriety court program before he or she successfully
completed it.
b. the court became aware that the defendant operated a motor vehicle that was not equipped with an interlock device.
c. the court became aware that the defendant
tampered with
circumvented
removed
a court-ordered interlock device without prior court approval.
d. the defendant was charged with a new violation of MCL 257.625.
5. The interlock device was removed from the defendant’s vehicle because:
Date
Judge
Bar no.
CERTIFICATION TO DEPARTMENT OF STATE (INTERLOCK PROGRAM)
MC 393 (6/18)
MCL 257.304, MCL 600.1084
Original - Court
Approved, SCAO
1st copy - Department of State
STATE OF MICHIGAN
CASE NO.
JUDICIAL DISTRICT
CERTIFICATION TO DEPARTMENT OF STATE
JUDICIAL CIRCUIT
(INTERLOCK PROGRAM)
Court address
Court telephone no.
Defendant’s name, address, and telephone no.
The State of Michigan
v
THE PEOPLE OF
DLN
DOB
TO: Department of State
1. The defendant has been admitted into the DWI/sobriety court program; and an approved, certified ignition interlock device
has been installed in each motor vehicle owned or operated, or both, by the defendant as required under MCL 257.625k
and MCL 257.625l.
2. Travel
is
is not
allowed under MCL 257.304(4)(b)(xi).
3. The defendant has successfully completed the DWI/sobriety court program.
4. Under MCL 600.1084(6), the Secretary of State is informed that:
a. the court ordered that the defendant be removed from the DWI/sobriety court program before he or she successfully
completed it.
b. the court became aware that the defendant operated a motor vehicle that was not equipped with an interlock device.
c. the court became aware that the defendant
tampered with
circumvented
removed
a court-ordered interlock device without prior court approval.
d. the defendant was charged with a new violation of MCL 257.625.
5. The interlock device was removed from the defendant’s vehicle because:
Date
Judge
Bar no.
CERTIFICATION TO DEPARTMENT OF STATE (INTERLOCK PROGRAM)
MC 393 (6/18)
MCL 257.304, MCL 600.1084