I/We do hereby consent that__________________________________________________________________
, a minor,
Last
First
Middle
date of birth _________________________
be granted a Florida driver license and assume the obligations imposed
by
section 322.09, F.S., unless
and until we (or I) notify the Department to withdraw this consent.
__________________________________________________________________________________________________
Parent or Guardian Signature
Parent or Guardian Name (Printed)
State of Florida:
County of _________________ Sworn and subscribed by me this ____ day of __________, 20____ AFFIX NOTARY PUBLIC OR SEALS D. L. EXAMINER |
State of Florida:
County of _________________ Sworn and subscribed by me this ____ day of __________, 20____ AFFIX NOTARY PUBLIC OR SEALS D. L. EXAMINER |
_________________________
Parent or Guardian I.D. _________________________ I.D # |
Drug and Alcohol Education Course Completed on ____________________________ (Examiner completes)
INSTRUCTIONS:
ANY Learner’s License issued on or after October 1, 2000 must comply with the following criteria before they are eligible to apply for an Operator’s License.
HSMV 71022A (10/01/00)