Fill and Sign the Notice to Employers of Ignition Interlock Restriction California Form

STR E ET ADDR E S S : M A I L ING ADDR E S S : CIT Y AND ZIP COD E : BR A NCH NAM E : NAM E OF DEF E NDA N T : S TRE E T A DDRE SS : M A I LI NG A D DRE S S: CITY AND ZIP CODE: H O ME T E L E PH O NE N O .:W O RK TE L E PH ONE NO.: DRIV E R' S L IC E N SE NO.: NOTICE TO EM P LOYERS OF IGNITION INTERLOCK RESTRICTION ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –––––SUPERIO R C OURT OF CALI F ORNIA,COUNTY OF FOR COUR T U S E ONLY ID- 150 C A S E NU M B E R: INSTRU C TIONS TO DEFENDA N T You are r e quired t o provi de this notice t o any employer who own s a veh i cle that y ou o perat e in the course and sc o pe of your employment w i t h that empl o y e r . Y o u a r e a l s o req u ired t o kee p t h is n o tic e i n y our possession o r w i th you r e m p l oyer's vehicle. NOT I CE TO EMPLOYER 1 . T h is i s t o i n form th e employer s o f th e a bove named defenda n t t h at t h e d ef e ndan t is req u ire d by court o r d e r to h ave i nsta l l e d, o n all vehicles t h at th e d ef e ndant own s o r op e r a tes , an i gnition interlock device pursuan t t o Vehicl e Co de section 23 5 75 et seq. 2 . T h is court o r d e r i s effectiv e (date): an d wi l l e x p ir e (date): 3 . Note: Veh i c le C o d e s e ctio n 2 3 57 6 provides: "[I]f a person i s re q uired to op e r a t e a m o tor vehicle in the c o urs e a n d scop e of h is or he r em p loyment an d if the vehic le i s own ed b y th e e m p loyer, t he p ers on may operate th a t vehicle without inst a llation of an ap p r o v ed i gnition interlock device if th e e m p loye r h a s b e e n n ot i fi ed b y the person th a t th e p e rso n 's drivin g privi l ege has been restricted .. . an d if th e p e r s o n h a s proo f o f t h at no t ification in his o r her possessio n , o r if th e n o tice, or a f a csimi le co p y thereof, i s w ith the v e hicle." 4 . T h i s n o tice satisfi e s the r e qu i rement s o f Ve h icle Code sect i on 23 576 . Fo r m A p pr ov e d f o r O p t i o n a l U s e Jud i cial C o un c i l o f C a li f or n ia ID - 15 0 [R ev . J u l y 1 , 2 0 0 5 ] NOTIC E TO EMPLOYER S OF IGNITION INTERLOCK RESTRICTION (Ignition Interlock Device) P a g e 1 of 1 V e hicl e C od e, §§ 2 3 5 7 5 , 2 3 576elec troni c form ã 2005 WWW.LawCA.co m L a w P u b l i s h e r s