CR-223 - Ignition Interlock Calibration Verification

Summary

Ignition Interlock Calibration Verification

Text

Form ID: CR-223
Title: Ignition Interlock Calibration Verification
Effective Date: 2021-01-01
Mandatory Form: no
Info Page: https://selfhelp.courts.ca.gov/jcc-form/CR-223
Primary Download URL: https://www.courts.ca.gov/documents/cr223.pdf
Form Detail Page:
Ignition Interlock Calibration Verification
(CR-223)
Get form CR-223
Effective: January 1, 2021
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How-to instructions for Criminal
PDF Text:
Form Approved for Optional Use 
Judicial Council of California 
CR-223  [Rev. January 1, 2021]
 IGNITION INTERLOCK CALIBRATION VERIFICATION Vehicle Code, § 23575
www.courts.ca.gov
CR-223
FOR COURT USE ONLY
CASE NUMBER:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY: STATE: ZIP CODE:
BRANCH NAME:
NAME OF DEFENDANT:
STREET ADDRESS:
MAILING ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
EMAIL ADDRESS:
DRIVER'S LICENSE NO.:
DATE OF COURT ORDER:
IGNITION INTERLOCK CALIBRATION VERIFICATION
1. Defendant's name:
2. Installer's name:
Address:
City: State: Zip Code:
Telephone no.:
3.  Vehicles: 
Make Model Year Color License Plate No. VIN:
a.
b.
c.
4. Installation date: a. b. c.
5. Odometer reading: a. b. c.
6. Calibration setting: a. b. c.
7. Unit serial no.: a. b. c.
8. Program to end (date):
9. The system is in calibration a. b. c.
10. The system has been inspected and is functioning properly. a. b. c.
11. Payment of $ + sales tax $ Total collected $ paid by
a. Credit card
b. Money order/cashier's check/certified check
c. Cash/personal check
I declare that the information provided is true and correct. 
Date:
(SIGNATURE OF INSTALLER)
DEFENDANT: Your next monitoring check is (date): . If you have not had your system serviced within a few 
days after a missed monitoring check, 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. You may also owe a missed appointment fee. 
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:
(SIGNATURE OF DEFENDANT)
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  Form ID: CR-223 Title: Ignition Interlock Calibration Verification Effective Date: 2021-01-01 Mandatory Form: no Info Page: https://selfhelp.courts.ca.gov/jcc-form/CR-223 Primary Download URL: https://www.courts.ca.gov/documents/cr223.pdf Form Detail Page: Ignition Interlock Calibration Verification (CR-223) …