Form 26-0117 "Court Abstract" - Arizona

What Is Form 26-0117?

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

Form Details:

  • Released on August 1, 2019;
  • The latest edition provided by the Arizona 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 26-0117 by clicking the link below or browse more documents and templates provided by the Arizona Department of Transportation.

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Download Form 26-0117 "Court Abstract" - Arizona

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Mail Drop 537M
Motor Vehicle Division
COURT ABSTRACT
1801 W Jefferson St
PO Box 2100
Phoenix AZ 85001-2100
 Amended
Clear
azdot.gov
26-0117 R08/19
Customer Name (first, middle, last, suffix)
Date of Birth
Street Address
City
State Zip
Driver License/ID Number
Class
State Vehicle Plate Number
State Make
Court ID Number Citing Agency
Violation Date
Approx. Speed Lawful Speed Accident
Serious Physical Injury
Fatality
 Yes  No
 Yes  No
 Yes  No
Complaint Number
Violation Code
 Misdemeanor
Court Docket Number
Disposition Code Disposition Date
Charge 1
 Felony
Drugs (13-3401) 28-1381A1
Alcohol Class/Treatment
Commercial Vehicle
Hazardous Material
16 or more Passengers
 Yes  No
 Yes  No
 Yes  No
 Yes  No
 Yes  No
Drug Only No Intoxicating Liquor (Effective 01/01/17)
Court has ordered Ignition Interlock for an
Sentencing Authority (28-661)
 Yes  No
Is the Court ordering Ignition Interlock?
additional _____ months.
 B  C
Complaint Number
Violation Code
 Misdemeanor
Court Docket Number
Disposition Code Disposition Date
Charge 2
 Felony
Drugs (13-3401) 28-1381A1
Alcohol Class/Treatment
Commercial Vehicle
Hazardous Material
16 or more Passengers
 Yes  No
 Yes  No
 Yes  No
 Yes  No
 Yes  No
Drug Only No Intoxicating Liquor (Effective 01/01/17)
Court has ordered Ignition Interlock for an
Sentencing Authority (28-661)
 Yes  No
Is the Court ordering Ignition Interlock?
additional _____ months.
 B  C
Complaint Number
Violation Code
 Misdemeanor
Court Docket Number
Disposition Code Disposition Date
Charge 3
 Felony
Drugs (13-3401) 28-1381A1
Alcohol Class/Treatment
Commercial Vehicle
Hazardous Material
16 or more Passengers
 Yes  No
 Yes  No
 Yes  No
 Yes  No
 Yes  No
Drug Only No Intoxicating Liquor (Effective 01/01/17)
Court has ordered Ignition Interlock for an
Sentencing Authority (28-661)
 Yes  No
Is the Court ordering Ignition Interlock?
additional _____ months.
 B  C
MANDATORY INSURANCE SUSPENSION
pursuant to:
 28-4135A
 Court directs MVD to suspend:  Driving Privilege
 28-4135B
 Vehicle Registration
 28-4135C
 Driving Privilege and Vehicle Registration
JUVENILE/UNDER AGE SUSPENSION
pursuant to the Court has:
 28-3320A7 Suspended driving privilege
 8-323 Suspended driving privilege
 28-3320D
Suspended driving privilege
 8-323 Restricted driving privilege
 28-3320B
Restricted driving privilege
 28-3322B
Restricted driving privilege 4-244(34) for ages 18-20
Beginning Suspension Date
Ending Suspension Date
Beginning Restriction Date
Ending Restriction Date
Restricted To
 Court has restricted the driving privilege
OTHER ACTIONS
 Court has suspended the driving privilege
Pursuant To
Beginning Date
Ending Date
 Court has revoked the driving privilege
Customer Signature
Date
I certify that the information
Presiding Judge/Court Clerk Signature
Date
above is true and correct.
White – MVD
Yellow – MVD (2nd Report)
Pink – Defendant
Gold – Court
Mail Drop 537M
Motor Vehicle Division
COURT ABSTRACT
1801 W Jefferson St
PO Box 2100
Phoenix AZ 85001-2100
 Amended
Clear
azdot.gov
26-0117 R08/19
Customer Name (first, middle, last, suffix)
Date of Birth
Street Address
City
State Zip
Driver License/ID Number
Class
State Vehicle Plate Number
State Make
Court ID Number Citing Agency
Violation Date
Approx. Speed Lawful Speed Accident
Serious Physical Injury
Fatality
 Yes  No
 Yes  No
 Yes  No
Complaint Number
Violation Code
 Misdemeanor
Court Docket Number
Disposition Code Disposition Date
Charge 1
 Felony
Drugs (13-3401) 28-1381A1
Alcohol Class/Treatment
Commercial Vehicle
Hazardous Material
16 or more Passengers
 Yes  No
 Yes  No
 Yes  No
 Yes  No
 Yes  No
Drug Only No Intoxicating Liquor (Effective 01/01/17)
Court has ordered Ignition Interlock for an
Sentencing Authority (28-661)
 Yes  No
Is the Court ordering Ignition Interlock?
additional _____ months.
 B  C
Complaint Number
Violation Code
 Misdemeanor
Court Docket Number
Disposition Code Disposition Date
Charge 2
 Felony
Drugs (13-3401) 28-1381A1
Alcohol Class/Treatment
Commercial Vehicle
Hazardous Material
16 or more Passengers
 Yes  No
 Yes  No
 Yes  No
 Yes  No
 Yes  No
Drug Only No Intoxicating Liquor (Effective 01/01/17)
Court has ordered Ignition Interlock for an
Sentencing Authority (28-661)
 Yes  No
Is the Court ordering Ignition Interlock?
additional _____ months.
 B  C
Complaint Number
Violation Code
 Misdemeanor
Court Docket Number
Disposition Code Disposition Date
Charge 3
 Felony
Drugs (13-3401) 28-1381A1
Alcohol Class/Treatment
Commercial Vehicle
Hazardous Material
16 or more Passengers
 Yes  No
 Yes  No
 Yes  No
 Yes  No
 Yes  No
Drug Only No Intoxicating Liquor (Effective 01/01/17)
Court has ordered Ignition Interlock for an
Sentencing Authority (28-661)
 Yes  No
Is the Court ordering Ignition Interlock?
additional _____ months.
 B  C
MANDATORY INSURANCE SUSPENSION
pursuant to:
 28-4135A
 Court directs MVD to suspend:  Driving Privilege
 28-4135B
 Vehicle Registration
 28-4135C
 Driving Privilege and Vehicle Registration
JUVENILE/UNDER AGE SUSPENSION
pursuant to the Court has:
 28-3320A7 Suspended driving privilege
 8-323 Suspended driving privilege
 28-3320D
Suspended driving privilege
 8-323 Restricted driving privilege
 28-3320B
Restricted driving privilege
 28-3322B
Restricted driving privilege 4-244(34) for ages 18-20
Beginning Suspension Date
Ending Suspension Date
Beginning Restriction Date
Ending Restriction Date
Restricted To
 Court has restricted the driving privilege
OTHER ACTIONS
 Court has suspended the driving privilege
Pursuant To
Beginning Date
Ending Date
 Court has revoked the driving privilege
Customer Signature
Date
I certify that the information
Presiding Judge/Court Clerk Signature
Date
above is true and correct.
White – MVD
Yellow – MVD (2nd Report)
Pink – Defendant
Gold – Court