Form TC 94-175 template
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Ignition Interlock Application
This document outlines instructions for applying for an Ignition Interlock Device in Kentucky. Applicants must provide proof of insurance, valid vehicle registration, and may need to submit a Breath Alcohol Ignition Interlock Physician Statement if diagnosed with diminished lung capacity. The application requires applicant and vehicle information including full legal name, email, phone, street address, city, state, zip, mailing address, driver license number, date of birth, vehicle identification numbers, plate numbers, year, make, model, and insurance company. The applicant must request authorization for the device and sign the application. A case number is assigned upon approval or denial with a reason given.
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