STATE OF WISCONSIN CIRCUIT COURT



STATE OF WISCONSIN CIRCUIT COURT SAUK COUNTY

[ ] STATE OF WISCONSIN

[ ] SAUK COUNTY

[ ] CITY/ VILLAGE OF ________________________

Plaintiff,

v. CASE NO: __________________

___________________________________________

___________________________________________, current address

___________________________________________

Defendant.

PETITION TO EXEMPT VEHICLES FROM IGNITION INTERLOCK REQUIREMENT

I, the above-named Defendant, petition the Court to exempt the following vehicle(s) from the Ignition Interlock Device requirement of § 343.301 of the Wisconsin Statutes.

I understand that I MUST have an ignition interlock device on any vehicle I operate. I will have or already have had an Ignition Interlock device installed on the following vehicles:

|Year |Make |Vehicle ID Number (VIN) |License Plate |

| | | | |

| | | | |

My reasoning for petitioning is as follows: _________________________________________

________________________________________________________________________________

________________________________________________________________________________

Attach Additional Pages if necessary

I have registered in my name, or my name appears on the title, to the following vehicles. (You may attach a list of these vehicles or a Department of Transportation printout of owned/registered/titled vehicles). This list must be complete or your request for an exemption may be denied. I am requesting to exempt the following vehicles:

|Year |Make |Vehicle ID Number (VIN) |License Plate |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

Under Oath I state that the above information is true and correct.

___________________________________________

Signature and Date

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