I H51 Dah Ih51

User Manual: iH51

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Office of the
Secretary of State
DEPARTMENT OF
ADMINISTRATIVE HEARINGS

DOCUMENTATION OF ABSTINENCE/
CHARACTER/SUBSTANCE USE

Additional forms may be obtained at
www.cyberdriveillinois.com

A petitioner must provide at least three original letters from individuals who have regular and frequent contact with him/her,
which include, at a minimum, the following information. This form may be completed and submitted in lieu of a letter.
Letters/forms must be signed and dated within 45 days if appearing in person for a hearing. If being submitted as part of a NonResident Out-of-State Hearing Application, the letters/forms must be signed and dated within 45 days of the postmark date.
If additional space is needed, please use the back of this form.

____________________________________________________

____________________________________________________

Petitioner’s Name (type or print)

Illinois Driver’s License Number

1.

What is your relationship to the petitioner (family member, friend, co-worker, etc.)?

2.

How long have you known the petitioner?

3.

How often do you see the petitioner (daily, weekly, monthly, etc.)?

4.

How long have you known the petitioner to be abstinent from alcohol and/or drugs? Be as specific as possible, providing
abstinence dates for each substance, if applicable. If the petitioner is still using alcohol/drugs, describe the frequency and
amount of alcohol/drug use and how long the petitioner has maintained that use.

5.

Describe any changes in lifestyle and general attitude you have observed in the petitioner since he/she has remained abstinent
or maintained the current use pattern.

6.

Describe the petitioner’s character and why you believe he/she will be a safe and responsible driver.

NOTE: Fellow members of a support group should not provide abstinence/character/substance use letters/forms
unless the members have regular and frequent contact with the petitioner outside the group meetings. If a fellow
member provides a letter/form, he/she must identify the frequency and extent of contact with the petitioner outside
of the group meetings.

____________________________________________________

____________________________________________________

Signature

Date

____________________________________________________________________________________________________________
Address/City/State/ZIP
Printed by authority of the State of Illinois. April 2015 — 5M — DAH IH 51.5
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