South Carolina Department of Motor Vehicles
SECTION 1 – JUDGE’S NAME | |
|By order of the Honorable | |, the minor |
| |(print) | |
listed on this form shall have his/her driving privilege to operate a motor vehicle in the State of South Carolina
restricted in the manner described below:
|SECTION 2 - MINOR’S INFORMATION |
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|Name: | |
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|Address: | |
| | | | | | |
|City: | |State: | |Zip Code: | |
| | | | |
|Credential Number: | |Date of Birth: | |
| | |
|Parent(s), Guardian or Custodian: | |
| | |
|Address: | |
| | | | | | |
|City: | |State: | |Zip Code: | |
| | | | | | |
|SECTION 3 - RESTRICTION INFORMATION |
| |
|SC Code of Law §16-17-500 (E)-(4) Tobacco Restriction- Minor |
| | |
|Effective Date of Restriction: | |
| | |
|Termination Date of Restriction: | |
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| |1. Driving privileges are restricted to driving to and from school. |
| | |
| |2. Driving privileges are restricted to driving to and from work. |
| | |
| |3. Driving privileges are restricted to driving to and from church. |
| | |
| |4. Driving privileges are restricted, as the court considers appropriate (additional instructions below). |
| | |
| |5. Minor is not licensed and the issuance of a driver’s license or beginner’s permit is delayed for 90 days after making application for a |
| |credential or until the minor’s 18th birthday. |
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|Additional Instructions: | |
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|SECTION 4 – COURT INFORMATION |
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|Date: | | |Judge’s Signature: | |
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|Court Name: | |
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|Court Address: | |
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