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STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
PARENT CONSENT FOR A DRIVER APPLICATION OF A MINOR

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:

  1. One parent or guardian must sign this form.
  2. All signatures must be notarized, or witnessed by an examiner.
  3. This form, social security card if you have been issued one, and birth certificate must be presented to driver licenses office by all customers under 18, unless married.
PARENTS/LEGAL GUARDIANS/RESPONSIBLE ADULT OVER 21 YEARS OLD WITH DRIVERS HOLDING A LEARNER'S LICENSE

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)