Free ID-120 IGNITION INTERLOCK CALIBRATION VERIFICATION AND TAMPER REPORT (IGNITION INTERLOCK DEVICE) - California

COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. :
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

Index No.
FOR COURT USE ONLY

ID-120

: Plaintiff(s) -against: : : :

Calendar No.

JUDICIAL SUBPOENA

NAME OF DEFENDANT: STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: HOME TELEPHONE NO.: WORK TELEPHONE NO.:

DRIVER'S LICENSE NO.:

Defendant(s) : ......................................................

DATE OF COURT ORDER:

THE PEOPLE OF THE STATE OF NEW YORK
IGNITION INTERLOCK

TO
1. Defendant's name: 2. Installer's name: Address: GREETINGS: City, state, ZIP: Telephone: WE COMMAND 3. Vehicles: Make the Honorable a. County of b. 4. This is the 5. 6. 7. 8. 9. 10. 11. 12. six-month a. a.

CALIBRATION VERIFICATION TAMPER REPORT

CASE NUMBER:

YOU, that all business and excuses being laid aside, you and each of you attend before Year the Color License Plate No. VIN Model , at Court located at in room , on the day of , 20 , at o'clock in the noon, and at any recessed c. or adjourned date, to testify and give evidence as a witness in this action on the part of the
yearly report (if relevant). b. c. c.

Installation date: Odometer reading:

b. Your failure to comply with this subpoena is punishable as a contempt a. b. Calibration setting: the party on whose behalf this subpoena was issued for a maximum penalty of b. Unit serial No.: a. Program to end (date): The system is in calibration.

result of your failure to comply.

ofc. court and will make you liable to $50 and all damages sustained as a c.

a. b. c. Witness, Honorable The system has been inspected and is functioning properly. Court in day of , The ignition interlock County,installed in vehicles devices a. 20 (Describe/additional comments):

a. b.

b. c.

, one c. the Justices of the of
show evidence of tampering.

+ sales tax $ Total collected $ paid by 13. Payment of $ a. Credit card (Attorney must sign above and type name below) b. Money order/cashier's check/certified check c. Cash/personal check I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:

Attorney(s) for
(SIGNATURE OF INSTALLER)

DEFENDANT: Your next monitoring check is (date): . If you have not had your system serviced within seven days of the due date, the system will shut down and you will be unable to start your car. It will be your responsibility to have your car towed to the calibration location. Office and P.O. Address Your next payment of $ is due at the above monitoring check. Payment must be made in full before service is performed. If payment is not made, the system may shut down and you may not be able to start your car. This will result in a service call that will be your responsibility. You may be required to make an additional payment for late payments. I acknowledge receipt of a copy of this form. Date:

Telephone No.: Facsimile No.: (SIGNATURE OF DEFENDANT) E-Mail Address: Distribution: Court, Manufacturer or Manufacturer's Agent, Defendant, Probation Department Form Approved for Optional Use Mobile Tel. No.: IGNITION INTERLOCK CALIBRATION Judicial Council of California
ID-120 [Rev. July 1, 2005]

Page 1 of 1 Vehicle Code, § 23575 www.courtinfo.ca.gov

VERIFICATION AND TAMPER REPORT (Ignition Interlock Device)

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