DWI CERTIFICATE RELEASE INSTRUCTIONS

CERTIFICATE RELEASE INSTRUCTIONS
STEP 1: Provide the following information for your Certificate:
Last Name
First Name
Middle Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Driver License number:
If you don't have it, leave it blank
Cause number:
YOU MUST PROVIDE THIS NUMBER FOR DPS TO PROCESS YOUR CASE
DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
County of Conviction:
Probation Officer Email (To send a copy of your Certificate)
STEP 2: Select the way the Certificate should be delivered
How the Certificate should be delivered to you?
I, {FirstName} {MiddleName} {lastName}, authorize ACES (Affordable Counseling and Educational Services) to mail my certificate to the address listed below.

Mailing Address:

{mailingAddress}

I understand and acknowledge that the estimated delivery time is 5–7 business days from the date the certificate is mailed.

I further acknowledge that once the certificate has been mailed, ACES Affordable Counseling and education services is not responsible or liable for any loss, delay, or damage that may occur while the certificate is in transit. I accept full responsibility for any issues arising after the certificate has been sent.

By signing below, I confirm that the mailing address is accurate and consent to receiving my certificate by mail under the stated terms.
Signature
Take a photo of your Driver License or another form of Picture ID

Cancelof
Should be Empty: