THE STATE OF NEW HAMPSHIRE
NH CIRCUIT COURT
Xth Circuit – District Division – Town
NOTICE OF REVOCATION
Case Name: State v. John Doe
Case Number: 000-2018-CR-0000
YOU HAVE BEEN CONVICTED OF:
X Driving While Intoxicated/Aggravated Driving While Intoxicated
Your license and/or operating privileges to drive in the State of New Hampshire have been revoked for a period of 9 months.
Based on this conviction, you must cease operating immediately. New Hampshire licensed drivers must immediately surrender their license or face further penalty. You cannot drive again until you have paid a $100.00 restoration fee and received written notice of restoration by the Director, Division of Motor Vehicles, Concord, New Hampshire. If your conviction is for Driving While Intoxicated or Driving While Under the Influence of Drugs, certain requirements are necessary for the reinstatement of your license or nonresident operating privileges:
- An SR-22 form must be filed by your insurance company, with the Motor Vehicle Division (a copy of your insurance policy is not sufficient).
- You must complete a 20 hour Impaired Driver Education Program (IDEP).
- If you are a first time, non-aggravated DWI offender you must obtain a substance screening at an Impaired Driver Care Management Program (IDCMP) within 14 days of
- If your screening is positive or you are convicted of Aggravated DWI, DWI 2nd or DWI subsequent, or you are under the age of 21, or you have a prior DWI 1st conviction within 10 years, you will be required to schedule a substance use disorder evaluation within 30 days from sentencing or discharge from the House of Corrections, complete that substance use disorder evaluation within 60 days and comply with the service plan that is developed.
A certificate of completion must be submitted to the New Hampshire Division of Motor Vehicles when you apply for restoration of your driving privileges.
- Out of state offenders must obtain an initial intake with a New Hampshire IDCMP. Education and treatment services may be provided in your home state with the approval of the
- New Hampshire residents must file an application for a new license with Motor Vehicle Division, HazenDrive, Concord, New Hampshire 03305 (if it has expired during the period of revocation).
Non-residents are restored at the end of the revocation period; however, you should not operate a vehicle in this State until such time that notice of restoration is received in writing. This revocation may also affect your driving privileges in your home state.
DO NOT DRIVE UNTIL RESTORATION IS RECEIVED. OPERATING AFTER REVOCATION OR SUSPENSION DUE TO DRIVING WHILE INTOXICATED IS A CLASS A MISDEMEANOR.
Current as of October 30, 2018
Impaired Driver Care Management Programs (IDCMP) and What They Offer
o Indicates limited services
Main Phone: 603-679-2100 Email: amethyst [email protected] fairpoint .net
• Main Office (Epping): 120 Hedding Road, NH 03042 *603-679-2100*
• Salem Offi ce: 35 Geremonty Drive, 603-679-2100
• Portsmouth Office: 1039 Unit D, Islington Street, 603-679-2100
• Claremont Office: 24 Opera House Square, The Moody Building Unit 301E, 603-679-2100
o Manchester Office: 814 Elm Street, 603-679-2100
|Chrysalis Recovery Center (CRC)|
Main Phone: 603-998-4210 Email: i[email protected].com
• Main Office (Concord): 112 South State Street, NH 03301 *603-998-4210*
• Franklin Office: 20Canal Street, 603-998-4210
• Northwood Office: 1130 1st NH Turnpike, Rt 4, *603-998-4210*
• Manchester Office: 15 High Street, 603-998-4210
|Community Alcohol Information Program (CAIP) Main Phone: 1-800-660-4246 Website: NHDWl–caip.com|
• Main Office (Boscawen): 119 N Main Street, PO Box 8507, NH 03303 * 1-800-660-4246*
• Keene Office: 103 Roxbury Street, 1-800-660-4246
• Laconia Office: 390 Union Ave, 1-800-660-4246
• Nashua Office: 3A Taggart Drive, 1-800-660-4246
|Community Improvements Associates (CIA)|
Main Phone: 603-352-1016 Email: [email protected] cianh.com
• Main Office (Keene): 170 Emerald Street, NH 03431 *603-352-1016*
• Manchester Office: 25 Lowell Street, 603-623-5052
|Homebase Collaborative Family Counseling|
Main Phon e: 603-402-9357 Email: i[email protected] .org
• Main Office (Manchester): 1850 Elm Street, *603-402-9357*
• Nashua: 5 Pine Street Ext Suite# 2, NH 03060, 603-402-9357
• Concord Office: 3 North Spring Street Suite 101, 603-402-9357
• Rochester Office: 29 Columbus Ave, 603-402-9357
Main Phone: 603-516-8160 Email: [email protected].strafford.nh.us
• Main Office (Dover): 272 County Farm Rd, NH 03820 *603-516-8160*
|North Country Health Consortium|
Main Phone: 603-259-3700 Email: nchcnh.org
• Main Office (Littleton): 262 Cottage St Suite 230, NH 03561 *603-259-3700*
• Berlin Office: 610 Sullivan Street, Suite 303, 603-259-3700
• Bethlehem Office: 2957 Main Street, 603-259-3700
• Center Con way: 1620 Main Street, 603-259-3700 o Woodsville Office: 6 Church St reet. 603-259-3700
See other side Revised 9/1/2018
YOU ARE ADVISED TO CONTACT THE IDCMP WITHIN THREE (3) DAYS TO SCHEDULE YOUR INTAKE APPOINTMENT. FAILURE TO DO SO MAY RESULT IN YOU NOT MEETING YOUR REQUIRED TIME FRAMES AND INCURRING ADDITIONAL PENALTIES.
In order for your intake to be conducted and screening)’evaluation instruments to be administered, you must provide the IDCMP with your sentencing order.
Prior to a finding being made as a result of your screening or evaluation, you must provide the IDCMP with all of the following:
- A current original certified copy of your driver’s license record from all of the following, as applicable:
- The State of New Hampshire Department of Safety, Division of Motor Vehicles;
- The state in which you hold a driver’s license, if a non-resident; and
- Any state in which you have been arrested or convicted for an offense involving drivinga motor vehicle under the influence of alcohol or
- Chemical test results, if any, or documentation of your refusal to submit to chemical
- A copy of your arrest report and arrest narrative relating to your conviction from the police department where the arrest
- Documentation of proof of completion of a department-approved impaired driver education program if such a program has been completed within the past S years .
- Intake $75.00, which shall be inclusive of any screening conducted;
- Client fee $70.00, to be paid to “Treasurer, State of NH”, which the IDCMP collects at the intake;
- Substance use disorder evaluation, $200.00;
- Impaired Driver Education Program (IDEP) including all course materials, $300.00;
- Weekend Impaired Driver Education Program (WIDEP), including all course materials and room and board, $485.00;
- Care management, $30.00 per contact, maximum $60.00 per month;
- For each day that an IDCMP staff is required to attend a sentencing court proceeding as a result of a notice of non-compliance being sent in accordance with He-A 0G(k), $100.00 per day.
- Out of state administrative fee, $350.00
*If you have not completed an approved educational program within the past five years,
you have a choice of attending either an IDEP or a WIDEP.
Payments are to be made •• follows:
- Intake and/or evaluation payment(s) are to be made on the date of service delivery, unless a payment plan has been agreed to between you and the IDCMP
- Client fee is collected by the IDCMP at the time of intake
- Care management contacts; the IDCMP may charge individually for each contact or on a monthly basis for two contacts, to be payable in a manner determined by the IDCMP.
- IDEP or WIDEP payment to be made on or before the date of the first session, unless a payment plan has been agreed to between you and the IDCMP; and
- You must pay for any drug or alcohol testing required by the service plan. Such fees shall be paid directly to the testing site.
- Out of state fee to be paid at time of intake, unless a payment plan has been agreed to between you and the IDCMP.