SmartMobile™ Removal Authorization

The following client is authorized to have their SmartMobile™ Alcohol Monitoring Device removed as of the date noted below.

This form is intended for state authorities to approve the discontinuation of someone’s SmartMobile™ device/program.

If you are attempting to have an Ignition Interlock removed from your vehicle, please refer to the Device Removal page instead.

Case Number* (required)

County* (required)

Client Name* (required)

Date of Birth* (required)

Removal authorized on or after* (required)

Authorized By* (required)

Email* (required)

Phone* (required)

File Uploads

Please upload any official documentation that may be required to authorize the removal.

Drop files here or

Accepted file types: jpeg, jpg, png, pdf, doc, docx, xls, xlsx, Max. file size: 63 MB, Max. files: 5.

Additional Information

Authorization Approval* (required)

By clicking Submit, you are authorizing the removal/de-enrollment of the breath alcohol monitoring (SmartMobile™) device for the person named herein.

Phone

This field is for validation purposes and should be left unchanged.