Ignition Interlock Voluntary Withdrawal Form - Minnesota 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Driver’s License Number, First Name, Middle Name, Last Name, and State of Issue in the Participant Information section.
3. Fill in your Address, City/Zip, Phone Number, Date of Birth, and Email Address to ensure accurate contact information.
4. Review the Certification section carefully. Acknowledge that you have received and agreed to abide by the Minnesota Ignition Interlock Device Program Guidelines by checking the box provided.
5. Sign and date the form at the bottom to verify that all information is truthful and accurate. This step is crucial as any false information may lead to termination from the program.

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