Dl 21sc 2026

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The document DL-21SC (4-07) is a self-certification form for individuals who own or operate vehicles and are required to install an ignition interlock device. It includes sections for driver information, vehicle details, ownership statements, and vendor verification. The form must be completed accurately to avoid legal penalties, and it provides instructions for submitting the form to PennDOT after installation of the device.

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Click ‘Get Form’ to open the dl 21sc in the editor.
In Section A, enter your full name, driver license number, and address. Ensure you provide a valid address as a P.O. Box cannot be used alone.
Proceed to Section B where you will list all vehicles you own or have permission to operate. Fill in the plate number, title number, VIN, and year/make for each vehicle.
In Section C, check the appropriate box indicating ownership status. Print your name, sign in ink, and date the form. If applying for a hardship exemption, ensure to attach your income tax return.
Section D is completed by the vendor after verifying your vehicle information. They will sign and date this section before submission.

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