Form DSD SR89 "Affidavit for Refund of Security Deposited or Termination of Surety Bond in Accordance With Section 7-214, Illinois Safety Responsibility Law" - Illinois

What Is Form DSD SR89?

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

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the Illinois Secretary of State;
  • 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 DSD SR89 by clicking the link below or browse more documents and templates provided by the Illinois Secretary of State.

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Download Form DSD SR89 "Affidavit for Refund of Security Deposited or Termination of Surety Bond in Accordance With Section 7-214, Illinois Safety Responsibility Law" - Illinois

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Submit completed form to:
Illinois Secretary of State
Office of the Secretar y of State
Driver Services Department
Safety Responsibility Section
Driver Ser vices Depar tment
2701 S. Dirksen Pkwy.
Springfield, IL 62723
Affidavit for Refund of Security Deposited or Termination of Surety Bond
in Accordance with Section 7-214, Illinois Safety Responsibility Law
Crash Number: ________________________________________________________________________________________________
Driver’s License Number: ________________________________________________________________________________________
(I/We), _______________________________________________________________________________, being duly sworn, depose:
1. (I/We) reside at _____________________________________, in the town/city of ________________________________,
County of _____________________________________, State of ______________, ZIP Code ___________ - ___________;
NOTE: THE ILLINOIS STATE COMPTROLLER REQUIRES YOUR 9-DIGIT ZIP CODE FOR PAYMENT.
2. On ____________________ , (I/we) (was/were) involved in a crash in or near ____________________________________,
Date
Illinois, as a result of which (I/we) became subject to the Illinois Safety Responsibility Law; and
3. Two years has elapsed since the driver’s license suspension date, and no suit for claims for damages and/or personal injuries
has been instituted or is now pending, nor does any judgment rendered remain unsatisfied.
Sign on applicable line. Signature must be signed in front of a
Notary Public or witnessed by someone not related to you.
______________________________________________________
Signature of Operator
______________________________________________________
Signature of Owner
Subscribed and sworn to before me this ____________________________ day of _________________________________, 20_____.
______________________________________________________
Name of Notary Public
______________________________________________________
Title of Notary Public
My commission expires ___________________________________
Printed on recycled paper.
Printed by authority of the State of Illinois. July 2018 - 5M - DSD SR 89
Print
Reset
Submit completed form to:
Illinois Secretary of State
Office of the Secretar y of State
Driver Services Department
Safety Responsibility Section
Driver Ser vices Depar tment
2701 S. Dirksen Pkwy.
Springfield, IL 62723
Affidavit for Refund of Security Deposited or Termination of Surety Bond
in Accordance with Section 7-214, Illinois Safety Responsibility Law
Crash Number: ________________________________________________________________________________________________
Driver’s License Number: ________________________________________________________________________________________
(I/We), _______________________________________________________________________________, being duly sworn, depose:
1. (I/We) reside at _____________________________________, in the town/city of ________________________________,
County of _____________________________________, State of ______________, ZIP Code ___________ - ___________;
NOTE: THE ILLINOIS STATE COMPTROLLER REQUIRES YOUR 9-DIGIT ZIP CODE FOR PAYMENT.
2. On ____________________ , (I/we) (was/were) involved in a crash in or near ____________________________________,
Date
Illinois, as a result of which (I/we) became subject to the Illinois Safety Responsibility Law; and
3. Two years has elapsed since the driver’s license suspension date, and no suit for claims for damages and/or personal injuries
has been instituted or is now pending, nor does any judgment rendered remain unsatisfied.
Sign on applicable line. Signature must be signed in front of a
Notary Public or witnessed by someone not related to you.
______________________________________________________
Signature of Operator
______________________________________________________
Signature of Owner
Subscribed and sworn to before me this ____________________________ day of _________________________________, 20_____.
______________________________________________________
Name of Notary Public
______________________________________________________
Title of Notary Public
My commission expires ___________________________________
Printed on recycled paper.
Printed by authority of the State of Illinois. July 2018 - 5M - DSD SR 89