Form SFN16862 "Drug Court Certification" - North Dakota

What Is Form SFN16862?

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

Form Details:

  • Released on November 21, 2016;
  • The latest edition provided by the North Dakota Department of Transportation;
  • 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 SFN16862 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Transportation.

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Download Form SFN16862 "Drug Court Certification" - North Dakota

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DRUG COURT CERTIFICATION
North Dakota Department of Transportation, Drivers License
SFN 16862 (11-2016)
INFORMATION TO THE APPLICANT
This application is to be completed and submitted in conjunction with the Temporary Restricted License Request. It shall be
completed by persons who are presently under suspension/revocation for a third or subsequent alcohol/drug related offense
and have been violation free for 365 days. All information submitted will be used to determine eligibility for a temporary
restricted license. An investigation will be conducted by Drivers License Division to determine the validity of all information
furnished.
The following information must be submitted before a determination will be made concerning eligibility for a temporary
restricted license:
1. Information from at least three individuals/sources advising of your conduct and verifying you have not driven for the
past 365 days may come from:
a. your employer
b. citizens in your community
c. local law enforcement
d. any others
2. A current favorable report from an addiction facility (within last six months).
3. Why you believe you need a temporary restricted license.
APPLICATION
Name of Applicant
Drivers License Number
Date of Birth
Telephone Number
The applicant states that for a period of 365 days prior to the date of this application, no offenses have been committed, and
understands that a hearing may be conducted for the purposes of using information, reports, and evaluations from courts, law
enforcement, and citizens to determine the applicant's conduct and driving behavior for the 365 day period prior to the filing
of this application.
DRUG COURT CERTIFICATION
I certify that the above applicant, is participating in the drug court program. To the best of my knowledge, this individual has not committed
an offense for a period of three hundred sixty-five days before the date of the filing of this written application.
A restricted license issued to a participant of the drug court program will be terminated should the Drivers License Division be notified of a
traffic violation or if the District Court notifies the Drivers License Division that the participant has not complied with the drug court
requirements.
District Judge
Date
DRUG COURT CERTIFICATION
North Dakota Department of Transportation, Drivers License
SFN 16862 (11-2016)
INFORMATION TO THE APPLICANT
This application is to be completed and submitted in conjunction with the Temporary Restricted License Request. It shall be
completed by persons who are presently under suspension/revocation for a third or subsequent alcohol/drug related offense
and have been violation free for 365 days. All information submitted will be used to determine eligibility for a temporary
restricted license. An investigation will be conducted by Drivers License Division to determine the validity of all information
furnished.
The following information must be submitted before a determination will be made concerning eligibility for a temporary
restricted license:
1. Information from at least three individuals/sources advising of your conduct and verifying you have not driven for the
past 365 days may come from:
a. your employer
b. citizens in your community
c. local law enforcement
d. any others
2. A current favorable report from an addiction facility (within last six months).
3. Why you believe you need a temporary restricted license.
APPLICATION
Name of Applicant
Drivers License Number
Date of Birth
Telephone Number
The applicant states that for a period of 365 days prior to the date of this application, no offenses have been committed, and
understands that a hearing may be conducted for the purposes of using information, reports, and evaluations from courts, law
enforcement, and citizens to determine the applicant's conduct and driving behavior for the 365 day period prior to the filing
of this application.
DRUG COURT CERTIFICATION
I certify that the above applicant, is participating in the drug court program. To the best of my knowledge, this individual has not committed
an offense for a period of three hundred sixty-five days before the date of the filing of this written application.
A restricted license issued to a participant of the drug court program will be terminated should the Drivers License Division be notified of a
traffic violation or if the District Court notifies the Drivers License Division that the participant has not complied with the drug court
requirements.
District Judge
Date