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AOC 4954 Rev 7 Page 1 of 2 Commonwealth of Kentucky

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PRETRIAL APPLICATION FOR AUTHORIZATION TO APPLY FOR AN IGNITION INTERLOCK LICENSE AND DEVICE

AOC-495.4

Rev. 7-15

Page 1 of 2

Doc. Code: PAI

Commonwealth of Kentucky

Court of Justice www.courts.ky.gov

KRS 189A.107; 189A.200;

189A.340; 189A.420

COMMONWEALTH OF KENTUCKY

COURT OF JUSTICE

Case No.

Court

County

Division

COMMONWEALTH OF KENTUCKY

VS.

PLAINTIFF

DEFENDANT

Address:

Comes the above-named Defendant, and requests authorization to apply to the Transportation Cabinet for the issuance of an ignition interlock license and permission to operate a motor vehicle/motorcycle equipped with a functioning ignition interlock device (IID):

1. My privilege to operate a motor vehicle in the Commonwealth of Kentucky is subject to suspension pending trial pursuant to KRS 189A.200.

2. I hereby acknowledge that by making this application, I have waived my right to judicial review of the license suspension in KRS 189A.200(2) pursuant to KRS 189A.107(1).

3. I am requesting authorization to apply to the Transportation Cabinet for the issuance of an ignition interlock license. I understand that I must meet the Cabinet's eligibility requirements in order to receive an ignition interlock license.

4. I am requesting permission to install IID(s) on the following vehicle/motorcycle(s): (List the make, model, year, and VIN number if known)

5. I understand that, unless I am indigent, I will be responsible for the reasonable cost for leasing, buying, installing, servicing, and monitoring the IID and that I must comply with all regulations of the Transportation Cabinet regarding the license and device.

6. I understand that I will not be permitted to operate any motor vehicle/motorcycle unless and until the ignition interlock license is issued by the Transportation Cabinet upon proof of the installation of an IID.

7. I understand that if I receive an ignition interlock license, I will only be permitted to operate a motor vehicle or motorcycle equipped with a functioning IID.

8. (check if applicable) I am requesting a WORK EXCEPTION from the IID requirement. I am required to operate an employer-owned motor vehicle/motorcycle in the course and scope of my employment with (name of employer) I ask the Court to allow me to operate an employer-provided motor vehicle/motorcycle that is not equipped with IID during regular work hours for the purposes of my job. My employer has been notified of the prohibition.

9. Submitted to the Court with this Application are: (a) Proof of motor vehicle insurance; and (b) If requesting a work exception, my employer has completed the NOTARIZED statement on page 2 of this form.

Date:

Defendant's Signature

Date:

Defendant's Attorney (if any)

Distribution:

White - Court File

Yellow - Defendant

Pink - County Attorney

AOC-495.4

Rev. 7-15

Page 2 of 2

Doc. Code: PAI

Directions to Employer: This statement must be completed and notarized as part of the Applicant's request to install an IID and obtain a work exception.

Employer's Statement

(1) is an employee of this company.

(2) A requirement of his/her employment, is the operation of an employer-provided motor vehicle or motorcycle.

(3) We are aware of the employee's license suspension or revocation of the ability to operate a motor vehicle due to a charge or conviction for driving under the influence.

(4) We are aware of the employee's request to the court that he/she be allowed to install an IID on a vehicle(s) registered to him/her, either jointly or individually.

(5) We are aware of the employee's request for a work exception. If granted by the Court, we understand that the employee will be permitted to operate an employer-provided motor vehicle or motorcycle which is not equipped with an IID for work purposes only and only during work hours.

(6) We understand that even if a work exception is granted by the Court, the defendant is restricted from using an employer's nonignition interlock equipped vehicle until the expiration of thirty (30) days from the date of issuance of an ignition interlock license for a first offense or twelve (12) months from the date of issuance of an ignition interlock license for a second or subsequent offense in violation of KRS 189A.010.

Signature of Employer

Title

Company Name

State of:

County of:

Subscribed and sworn to before me this day of 2

My commission expires: Notary Public

INSTRUCTIONS TO DEFENDANT:

If the Court authorizes you to apply for an ignition interlock license, you must complete the Transportation Cabinet's application form and submit it to the Transportation Cabinet. There is a nonrefundable fee for the application. The Cabinet may refuse approval of an ignition interlock license should your driving history reveal a current withdrawal, denial, suspension, cancellation, or revocation of driving privilege in any state/licensing jurisdiction. You can request a copy of your driver history from the DOT prior to submitting your application and nonrefundable fee to find out if you have a pending restriction of your driving privilege.

If the Cabinet indicates you are eligible for a license, you must then choose an approved IID provider and have a functioning IID installed on the vehicle(s) and/or motorcycle(s) you designated. A certificate of installation of an IID must be provided to the Transportation Cabinet prior to the issuance of an ignition interlock license.

If you are indigent, you may complete AOC-495.8, Affidavit of Indigency and Request for Reduced Costs.

IF YOU ARE COMPLETING THIS FORM ON A COMPUTER, SUBMIT THREE (3) SIGNED COPIES OF THE APPLICATION [PLUS PROOF OF INSURANCE] TO THE CIRCUIT CLERK. If you received this application from the circuit clerk, submit only the completed three-page carbon back [plus the proof of insurance] to the Circuit Clerk.

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What AOC 4954 Rev 7 Page 1 of 2 is and when it applies

AOC 4954 Rev 7 Page 1 of 2 is a Commonwealth of Kentucky court form issued by the Administrative Office of the Courts. It is a state-specific judicial document used to record case-related facts and parties, and it often accompanies filings submitted to a county circuit or district court. The form must be completed accurately, including party identification, case number, and dates; where required by the court, signatures may need notarization or witness attestation. Electronic completion and eSigning are acceptable where the court’s local rules and applicable federal or state e-signature statutes allow.

Why accurate completion matters for AOC 4954 Rev 7 Page 1 of 2

Completing the form correctly reduces delays, preserves legal rights, and ensures the court record is usable for hearings and enforcement. Accurate party data, correct dates, and legible signatures limit rejection risk and support timely case processing under applicable state and federal e-signature rules.

Why accurate completion matters for AOC 4954 Rev 7 Page 1 of 2

Who typically completes and files this Kentucky AOC form

Confirm local court rules or clerk instructions before filing; some counties require original ink signatures, notarization, or electronic submission steps that vary by jurisdiction.

  • Litigants and self-represented parties who must provide factual statements or requests to the court.
  • Attorneys and paralegals preparing pleadings and exhibits tied to an active case file.
  • Court clerks or administrative staff who process, accept, and docket incoming filings.

Core elements found on AOC 4954 Rev 7 Page 1 of 2

A completed AOC 4954 Rev 7 Page 1 of 2 typically contains party and case identification, factual statements, signature and date fields, and a space for clerk notation — each area serves a distinct legal and procedural role.

Form Header

Contains court name, county, and case number so the filing is matched to the correct docket and case file in the clerk’s office.

Party Information

Lists plaintiff/petitioner and defendant/respondent names and contact details; consistency with other filings is essential to avoid processing errors.

Statement of Facts

A concise factual section for the matter at issue; keep language direct and confined to relevant facts to support the court record.

Signature Block

Includes signature, printed name, title (if applicable), and date; check whether a notary or witness is required by local rule.

Notary / Witness Area

When required, space for notary acknowledgment or witness attestation appears here; follow state notary and witness standards precisely.

Clerk Use

Reserved for clerk stamps, filing date, or docketing information used to validate acceptance and create the official file entry.

Step-by-step: filling out and submitting AOC 4954 Rev 7 Page 1 of 2

Follow these sequential steps to complete, authenticate, and file the form with minimal risk of rejection.

  • 01
    Gather documents: Collect IDs, existing case filings, and supporting exhibits.
  • 02
    Complete fields: Enter names, numbers, dates, and addresses accurately.
  • 03
    Sign and authenticate: Sign in ink or use an accepted e-signature method where allowed.
  • 04
    File with clerk: Submit per local rules: in-person, mail, or approved e-filing channel.

Configuring an online workflow for this AOC form

When using an eSignature or document platform, set up these basic workflow settings before sending documents for signature.

Field Configuration
Authentication Email link or SMS code based on court acceptance.
Notifications Enable signer reminders and completion alerts.
Template Create a reusable template for consistent filings.
Storage Archive completed PDFs in searchable case folders.

Typical digital filing flow for the Kentucky AOC form

A standard e-filing or electronic workflow follows predictable stages from upload to clerk acceptance.

  • Upload Document: Load the completed PDF or form into the platform.
  • Place Fields: Add signature, date, and initials fields in the correct locations.
  • Authenticate Signer: Confirm signer identity using the chosen authentication method.
  • Submit to Clerk: Deliver the executed document via the court’s approved channel.

Technical considerations for eSigning and eSubmission

Verify acceptance with the local clerk: rules on e-filing, RON notaries, and required metadata differ by county and by case type.

  • Supported Formats: PDF and DOCX are widely accepted for Kentucky court filings.
  • Signer Authentication: Use email, SMS code, or stronger identity checks as court rules require.
  • Integration Needs: Confirm integration with your case management or cloud storage systems.

Timing and filing expectations to watch for

Deadlines and response windows vary by case type and county; consult local court rules and the clerk for exact timelines.

Filing Deadline:

Varies by case; follow the judge’s scheduling order or local rule.

Service Period:

Service timelines for opposing parties depend on the pleading and statute involved.

Notary Validity:

Notarial acknowledgments must comply with Kentucky notary standards when required.

Clerk Processing:

Processing times depend on workload; allow extra days for mail submissions.

Retention Start:

Retention typically begins on the filing or execution date.

Common mistakes that delay acceptance

  • Entering an incorrect case number that causes the clerk to misfile the document and require refiling.
  • Using inconsistent party names across filings, which may create identity or service problems in the docket.
  • Omitting a required notary or witness block when local rules mandate such authentication for the document.
  • Submitting scanned, low-resolution signatures or illegible text that prevents clear indexing in the court record.

Risks and potential consequences of errors

Rejected Filing: Clerk may refuse to accept the document.
Missed Deadlines: Late filings can forfeit rights or remedies.
Perjury Risk: False statements may trigger sanctions or criminal exposure.
Service Defects: Improper service can delay proceedings.
Additional Fees: Refiling or corrective submissions may incur costs.
Record Confusion: Inconsistent entries complicate case management.

Essential data elements to have on hand

Full Name: Exact legal name
Case Number: Complete docket number
Court Name: County and court division
Address: Street, city, state, ZIP
Date: MM/DD/YYYY format
Signature: Signer name and date

Comparing signNow pricing and core features with major eSignature vendors

A neutral comparison of starting prices and common plan capabilities for signNow and widely used competitors to inform tool selection for court and administrative workflows.

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Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial Yes, 7-day free trial Varies by plan Varies by plan Varies by plan Varies by plan
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HIPAA Compliant Yes Yes Yes No No
Envelope Cap No cap 100 envelopes/user/year Varies by plan Varies by plan Varies by plan

Frequently asked questions about completing and submitting AOC 4954 Rev 7 Page 1 of 2

Answers to common operational and legal questions encountered when preparing and sending this Kentucky court form.


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