Government Forms Series 3a
Complete the information in the form.
Yes
No
I have had a driver's license or permit
other than in Minnesota
within the last ten (10) years.
Yes
No
Do you have any medical condition that may impair your ability to safely operate a motor vehicle? If YES, explain
Yes
No
Do you use insulin?
Yes
No
Do you use any medication, other than insulin, to control loss of consciousness or voluntary control? If YES, explain
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