security deposit form

Security Deposit Form Instructions (DSD SR-81.1) Illinois Secretary of State Jesse White Driver Services Department Safety & Financial Responsibility Section 2701 South Dirksen Parkway Springfield, Illinois 62723 Attached is the Security Deposit Form you requested. Please complete the form and submit it to our office at the above address. Please be aware of the following procedural facts in connection to the Security Deposit Form: 1. Please make certain that the Security Deposit Form is completed in its entirety. 2. Please note that personal uncertified checks are not acceptable by law as payment for Security Deposits. 3. Please include your Driver’s License Number, full name and Date of Birth on the Security Deposit form that is submitted to our office. 4. If you deposit security after the date of suspension, you will also be required to file Proof of Financial Responsibility in the form of an SR22 Certificate of Insurance. The SR22 is an insurance certificate filed with our office directly from authorized insurance companies. Once filed, the SR22 must be maintained for 36 months. Failure to renew your insurance will result in an immediate Driver’s License Suspension. If you have not already filed your SR22, please contact your insurance agent regarding this requirement. 5. Please allow 10 working days for our office to process your security deposit. If you are submitting an SR22 Certificate, please allow 10 to 20 working days for processing. You may check the status of your driver’s license by calling our automated attendant at 217-782-3720 and selecting option number one. You will then be asked to enter your driver’s license and social security numbers. The automated attendant will inform you if your driving privileges are valid or suspended. If it is still suspended, we have not processed your deposit yet. If it is valid, then your paperwork has been processed and a letter is on the way to you by U.S. Mail. You can drive as soon as your record is valid. This service is provided to you 24 hours per day. SECURITY DEPOSIT Accordance with Section 7-205, Illinois Safety Responsibility Law State of Illinois Office of Secretary of State Safety Responsibility Section Springfield, Illinois 62723 When depositing security as a method of compliance with the Illinois Safety Responsibility Law, please complete this form and attach with the deposit. Please provide the following information on the operator of the vehicle: Complete Name Date of Birth Address City ZIP Code (The Office of the Illinois State Comptroller now requires that you provide your nine-digit ZIP code) Driver’s License Number Date of Accident Accident Number In order to process the deposit, please provide answers to the following questions: 1. Amount of deposit $ ____________________ NOTE: The security deposit must be made payable to the Secretary of State 2. Method of payment (check one of the following) Money order Certified check Bank draft Cashier’s check NOTE: Personal uncertified checks will not be accepted 3. Does the security deposit cover the Operator involved in the accident? Yes 4. No Does the security deposit cover the Owner involved in the accident? Yes No 5. In whose name should the security deposit receipt be issued? __________________________________________________________________ (Please list complete name) ________________________ Date __________________________________________________ Signature of Depositor DSD SR-81.1

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