State of tennessee department of safety
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STATE OF TENNESSEE DEPARTMENT OF SAFETY & HOMELAND SECURITY
ORDER FOR RESTRICTED DRIVER LICENSE (MUST BE COMPLETED BY THE COURT OF JURISDICTION)
IF YOU HELD A VALID/NON-EXPIRED DRIVER LICENSE ON THE DATE THIS ORDER WAS ISSUED, THE ORDER CAN BE USED AS A 10-DAY TEMPORARY RESTRICTED LICENSE. YOU MUST APPLY AT A DRIVER SERVICE CENTER FOR A RESTRICTED LICENSE ? INSTRUCTIONS ON BACK.
STATE OF TN vs. (full name) DATE OF ARREST: CHARGE: DISPOSITION:
CONVICTION DATE: COURT:
PENDING DUI CHARGE
DRIVER LICENSE NO: DATE OF BIRTH: COUNTY: DOCKET NO:
Upon application of the Defendant for a restricted driver license, it appears to the Court that the Defendant has been: Convicted of, or pending action for, DUI (TCA 55-10-401) and does not have a prior conviction of aggravated vehicular homicide, vehicular homicide, aggravated vehicular assault, or vehicular assault, or a similar offense in another state, and the offense was not the proximate cause of death or serious bodily injury to another person (TCA 55-10-409(a)) Suspended under the implied consent law (TCA 55-10-407 & 55-10-408) Revoked for a conviction of drag racing (TCA 55-10-502) Suspended for an 18-20 alcohol violation by a minor (TCA 57-5-301) or a violation of the drug free youth act (TCA 55-10-701) Suspended for a conviction of driving away from fuel pump without paying for fuel (TCA 39-14-151) It further appears to the Court that the Defendant needs a restricted driver license for the purposes set forth in TCA 55-10-409 and TCA 55-50-502(c)(3). This restricted license is temporary and subject to revocation, if the Department determines you are not eligible pursuant to the above statutory laws. This is only valid until the Department has had an opportunity to make a final determination of eligibility for a restricted license.
IGNITION INTERLOCK DEVICE (IID) REQUIRED?
FAILURE TO MARK APPROPRIATE BOXES WILL RESULT IN DENIAL BY THE DEPARTMENT UNTIL A CORRECTED COURT ORDER IS RECEIVED
NO, IGNITION INTERLOCK NOT REQUIRED
Court Findings (must be recorded):
IMPLIED CONSENT WITH NO PRIORS TCA 55-10-409(b)(2)(B)(iv)
DUI BAC IS NOT .08% OR ABOVE AND NO DRUGS BAC _____% DUI DID NOT INVOLVE ALCOHOL AND (all below must be true to waive requirement) NO ACCIDENT DUE TO DUI NO PERSON UNDER 18 IN VEHICLE NO PRIOR DUI WITHIN 10 YEARS
GEOGRAPHIC RESTRICTIONS BELOW MUST BE FILLED OUT
YES, IGNITION INTERLOCK REQUIRED (mark all that apply) YES, DUI BAC .08% OR HIGHER TCA 55-10-409(b)(2)(B)(i) YES, DUI WITH ANY BAC AND DRUGS TCA 55-10-409(b)(2)(B)(i) YES, PERSON UNDER 18 IN VEHICLE TCA 55-10-409(b)(2)(B)(ii) YES, ACCIDENT DUE TO DUI TCA 55-10-409(b)(2)(B)(iii) YES, VIOLATION OF IMPLIED CONSENT AND PRIOR CONVICTION
(PAST FIVE YEARS) FOR TCA 55-10-409(b)(2)(B)(iv) YES, PRIOR DUI WITHIN 10 YEARS
TCA 55-10-409(b)(1)(B)(i) TCA 55-10-409(d)(2) YES, DRIVER REQUESTED TCA 55-10-409(b)(2)(C) YES, COURT DISCRETION
TCA 55-10-409(b)(2)(D) or TCA 55-50-502(c)(4) TCA 55-10-409(b)(1)(A)(ii) TCA 55-50-502(c)(3) If IID required, probation is also required per TCA 55-10-417(a)(3) Probation Officer______________________ Phone_________________________ GEOGRAPHIC RESTRICTIONS ARE ALSO REQUIRED AND ARE LISTED BELOW
Interlock required after reinstatement: Yes No : TCA 55-10-417(a)(1) Time _______ (months) or TCA 55-10-417(k) (6 months)
(Note to IID Provider: An IID Provider shall not install an IID until the above information is supplied by the Court)
Information below must also be completed on all other convictions requiring geographic restrictions. Furnish complete name and address (street #, street name, city
& state) of each location being requested. If you have geographic restrictions, these are the ONLY locations and/or dates/times you will be authorized to operate a
motor vehicle. Your correct home address should appear on your restricted driver license.
Type of Employment:
Court Ordered Alcohol Safety Program
Meeting/Function with Probation Officer
Regular Place of Worship
Scheduled Interlock Monitoring Appointment
Outpatient Alcohol/Drug Treatment Program
Home (If not address on Driver License)
Permitted Days: Sun Mon Tues Wed Thurs Fri Sat
Permitted Driving Hours: (State from time you leave home until return): __________ AM to ___________ PM
It is therefore ORDERED that the Defendant be issued a restricted driver license for the purposes and with the conditions set forth above, subject to state laws and the rules and regulations of the Department of Safety and Homeland Security of the State of Tennessee.
DATE SF-0680 (Rev. 08/18)
COURT NAME & SEAL/STAMP RDA-1348
IF YOU DRIVE OUTSIDE OF TENNESSEE, IT IS SUGGESTED THAT YOU OBTAIN WRITTEN PERMISSION FROM THE APPROPRIATE AUTHORITY IN THAT JURISDICTION.
Your privilege to drive cannot be under revocation/suspension/cancellation for any other reason in Tennessee or any other state. Applicant will be required to meet all requirements to clear any such revocation/suspension/cancellation before issuance of the restricted driver license.
I. INSTRUCTIONS FOR ISSUANCE OF A RESTRICTED LICENSE FOR DUI, IMPLIED CONSENT, OR DRAG RACING
The state statute provides a restricted driver license can be issued under limited circumstances. Unless the Court has authorized a license with an ignition interlock device and NO geographic restrictions, your privilege to drive, other than the approved restrictions, is REVOKED or SUSPENDED and driving PROHIBITED per state statute. TO BE ELIGIBLE FOR THIS RESTRICTED DRIVER LICENSE:
If applying for a restricted license, after a Driving Under the Influence conviction, you must not have been convicted of a prior Aggravated Vehicular Homicide as the proximate result of intoxication, Vehicular Homicide, Aggravated Vehicular Assault, or Vehicular Assault.
If applying for a restricted license, after a Driving Under the Influence conviction, you cannot have been involved in an accident in which a person was killed, or suffered serious bodily injury, as the approximate result of the Driving Under the Influence violation.
If restricted to vehicle(s) with an ignition interlock device, such device must be installed on the vehicle before applying for the restricted driver license and must be used while operating the vehicle in order for the restricted license to be valid. For a list of ignition interlock service center locations or information regarding the "Compliance Based Removal Law (TCA 55-10-425) effective July 1st, 2018, you can visit the Department of Safety and Homeland Security's website at
If restricted to vehicle(s) with an ignition interlock device, the restriction shall be a condition of probation or supervision for the entire period of the restriction per TCA 55-10-417(a)(3). Probation contact information must be completed on the front of the order.
Go to a Driver Services Center within ten (10) days of the date of this Court Order and present two (2) copies of this Order along with one (1) of the following: SR-22 insurance form (policy or any other document is not acceptable), a Financial Responsibility Bond, or $60,000 in cash or Corporate Surety Bond. If the Court or statute requires the driver be restricted to vehicles with a functioning ignition interlock device, the device must be installed on the vehicle and verified by the Department of Safety and Homeland Security. Upon paying the required license fees, a 90day interim license will be issued; the license fee is $65.00 and the application fee is $2.00. One (1) copy of the Court Order will be returned to you and must be kept with the temporary driving permit and with the restricted license you receive by mail. Barring any complication, an original restricted license will be mailed to you within the 90 days.
II. INSTRUCTIONS FOR ISSUANCE OF A RESTRICTED LICENSE FOR A JUVENILE OFFENDER (Drug/Alcohol Violations Under 21 Years of Age)
The Drug Free Youth Act or 18-20 Alcohol Violation statute provides a restricted driver license can be issued upon presenting clear and convincing evidence of an economic, educational, or health related hardship will result without such license. Such license SHALL NOT be granted for travel to and from social events or extracurricular school activities. Driving is permitted ONLY to and from place of employment and educational institution if reasonable parental/public transportation is unavailable, or free transportation is not provided by the educational institution. Privilege to drive, other than these restrictions, is SUSPENDED and driving PROHIBITED per state statute. TO BE ELIGIBLE FOR THIS RESTRICTED DRIVER LICENSE:
If violation is a 2nd or subsequent conviction, must serve a one (1) year suspension or until offender reaches the age of 17, whichever is later.
Go to a Driver Services Center within ten (10) days of the date of this Court Order and present two (2) copies of the Order along with proper identification. If under the age of 18, you will need a new Teenage Affidavit. A new Compulsory School Attendance form will be required ONLY if no previous permit/license has ever been issued or a truancy violation has occurred. Upon paying the required license fee (application fee of $20.00), a 90-day interim license will be issued. Barring any complication, an original restricted license will be mailed to you within the 90 days.
III. INSTRUCTIONS FOR ISSUANCE OF A RESTRICTED LICENSE FOR DRIVING AWAY FROM PUMPS WITHOUT PAYING FOR FUEL
TCA 39-14-151 provides a person suspended for driving away from pumps without paying for fuel may be issued a restricted license for the purpose of driving to and from work and in the course of employment, or to and from a college/university if a full time student. Upon obtaining the order for the restricted license from the court, the order, $65.00 license fee, and $2.00 application fee should be presented at a Driver Services Center to make application for the restricted license.
IV. INSTRUCTIONS FOR ISSUANCE OF A RESTRICTED LICENSE IN PENDING DUI CASE
TCA 55-50-502(c)(3) allows for a judge to order a DUI offender to only drive to and from their place of work or to drive a vehicle equipped with an ignition interlock device while a DUI charge is pending. This restriction is in addition to any other restrictions on the license at the time - if interlock is already required due to a prior revocation, you will be required to maintain interlock while driving to and from work on the Pending DUI restricted license. Upon paying the required license fees, and providing an SR-22 insurance form (policy or any other document is not acceptable), a 90-day interim license will be issued; the license fee is $65.00 and the application fee is $2.00. One (1) copy of the Court Order will be returned to you and must be kept with the temporary driving permit and then with the restricted license you receive by mail. Barring any complication, an original restricted license will be mailed to you within 90 days.
FOR YOUR RESTRICTED LICENSE TO BE VALID FOR DRIVING, THIS ORDER MUST BE KEPT WITH YOUR LICENSE AT ALL TIMES. IF YOU HAVE NEVER BEEN LICENSED IN TENNESSEE, THEN YOU WILL BE REQUIRED TO MEET ALL REQUIREMENTS OF A NEW RESIDENT IN ADDITION TO THE ABOVE REQUIREMENTS.
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