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1. Which DMV office notified you: 2. What DMV action is pending: 3. What is the effective date of the action: 4. Why is the DVM acting:

5. How many DMV points do you have: a. In the last 12 months b. In the last 24 months c. In the last 36 months

6. Is your commercial license at stake:

7. Which court (s) convicted you or Forfeited your bail: FIRST POINT IN TIME a. First court location/name and court number b. Vehicle code violation number c. Date of conviction d. Did you just pay the fine w/o an appearance before a judge? e. Which state convicted you? f. Was the point assigned b/c of an accident? SECOND POINT IN TIME a. Second court location/name/court number b. Vehicle code violation number c. Date of conviction d. Did you just pay the fine w/o an appearance before a judge? e. Which state convicted you? f. Were you assigned a point b/c of an accident? THIRD POINT IN TIME a. Third court location/name/court number b. Vehicle code violation number c. Date of conviction d. Did you just pay the fine w/o an appearance before a judge? e. Which state convicted you? f. Were you assigned a point b/c of an accident? FOURTH POINT IN TIME (unless you are a commercial driver earning 1.5 points per moving violation) a. Fourth court location/name/court number b. Vehicle code violation number c. Date of conviction d. Did you just pay the fine w/o an appearance before a judge? e. Which state convicted you? f. Were you assigned a point b/c of an accident?

8. Have you obtained a print out from your local DMV office

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