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					                                   CAUSE NO. _______________________

THE STATE OF TEXAS                                             §             COUNTY COURT AT LAW

VS.                                                            §             IN AND FOR

_______________________________________                        §             SMITH COUNTY, TEXAS
OFFENSE: _____________________________
DRIVER’S LICENSE NO._________________

             APPLICATION TO RELEASE IGNITION INTERLOCK DEVICE
       On this the ________ day of ________________________, 20__________, comes now the Defendant in the above
numbered and styled cause requesting this Court to Order the removal of the ignition interlock device installed on this
defendant’s vehicle on __________________ (Date installed) for the following reason(s):

This device was ordered to be installed as a (CHECK ALL THAT APPLY):

                 Condition of PROBATION
                 DATE DISCHARGED _______________________________________
                 Condition of BOND
                 DATE OF DISPOSITION AND PUNISHMENT ASSESSED
                 _______________________________________ _______________________________________________
                 Condition of OCCUPATIONAL DRIVERS LICENSE
                 DATE ENTERED         _______________________________________
                 OTHER                     _________________________________________________________________

         I, _________________________ (PRINT NAME), certify that I have completed all requirements under the
provisions of the law, have no other restrictions, including an Occupational License, requiring further installation of this
device, and am eligible to have this device removed.

                                                            ________________________________________
                                                            DEFENDANT’S SIGNATURE

SUBSCRIBED AND SWORN before me by the said Defendant on this the __________ day of
____________________, 20_________.
                                   Judy Carnes, County Clerk, Smith County, Texas

                                                   _______________________________________________________
                                                                     Deputy Clerk
OR
                                                   ________________________________________________
seal                                               NOTARY PUBLIC IN AND FOR SMITH COUNTY, TEXAS
                                                   My Commission expires_____________________________________

                           ORDER TO RELEASE INTERLOCK DEVICE
        After reviewing the reasons set out in this Defendant’s Application and In accordance with Texas Transportation
Code, Section 521.2465(b), this Court hereby GRANTS / DENIES this Defendant’s Application to Release Ignition Interlock
Device.
        ORDERED on this the ______ day of __________________, 20___.


                                                            _______________________________________
                                                            THOMAS A. DUNN, JUDGE
                                                            County Court at Law
                                                            Smith County, Texas

				
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