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