Section Tra 311.04 - Request for a DWI Sign Assembly, Name Plaque, or Both(a) An applicant requesting a DWI sign assembly, name plaque, or both, shall provide the following information on a form furnished by the bureau of traffic: (1) The name, address, and telephone number, or other means of contacting the applicant during regular business hours;(2) The applicant's relationship with the victim;(3) The date of the traffic accident;(4) The location of the traffic accident;(5) The name of the motor vehicle driver driving while intoxicated or under the influence of drugs;(6) A certified copy of a conviction for violation of RSA 265-A:2 or RSA 265-A:3 by one of the drivers involved in the fatal accident, evidencing that the individual(s) to be memorialized was/were fatally injured in the traffic accident to establish that one of the drivers was at fault and impaired by drugs or alcohol.(7) The name of the individual(s) fatally injured, as it or they should appear on the name plaque(s); and(8) The required fee of: a. $250.00 if a DWI sign assembly for the traffic accident does not exist; orb. $200.00 to add a name plaque to an existing DWI sign assembly for a victim of the same traffic accident.(b) Notwithstanding (a)(6) above, if a certified copy of conviction is not available due to lack of prosecution due to death of the impaired driver or other inability to prosecute unrelated to sufficiency of evidence, then the following documents shall be considered by the department in determining that one of the drivers was at fault and impaired by drugs or alcohol.(1) Relevant medical records to show the driver in a vehicle collision was impaired by drugs or alcohol;(2) Investigating officer's accident report that indicates the driver of one of the vehicles was impaired by drugs or alcohol; or(3) Other reliable records provided by the applicant indicating one of the drivers was impaired due to drugs or alcohol;N.H. Admin. Code § Tra 311.04