State of [Your State], County of [Your County]

I, [Your Name], residing at [Your Address], hereby submit this Ignition Interlock Affidavit in compliance with the laws of [Your State]. This affidavit serves to certify my adherence to court-ordered requirements following my conviction for driving under the influence (DUI) or driving while intoxicated (DWI) offense.

Statement of Facts

I attest to the following regarding the installation, maintenance, and utilization of the ignition interlock device:

1. The ignition interlock device was installed by a certified technician or authorized service provider in my vehicle, as per court specifications.

2. I have diligently maintained the ignition interlock device in good working condition, scheduling regular maintenance appointments as required.

3. I have faithfully utilized the ignition interlock device as instructed, ensuring proper operation each time I start my vehicle and complying with additional testing requirements.

4. I confirm that I have not tampered with or attempted to bypass the ignition interlock device at any time, and I have cooperated fully with monitoring and reporting requirements.

Oath and Affirmation

I, [Your Name], solemnly affirm that all statements made herein are true and accurate to the best of my knowledge and belief. I understand that any false statements can result in penalties as provided by law, including but not limited to, monetary fines, forfeiture of rights, and/or imprisonment.

Signature

[Your Name]
[Date]

NOTARY PUBLIC INFORMATION:

On this [Date], the undersigned personally appeared and swore under the penalties of perjury that the contents of the document are truthful and accurate to the best of his/her knowledge.

[Notary Public Name]

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