Date of Birth (mm/dd/yy)
Street Address
City/State/Zip
Petition for a Variance of Minnesota Rules, Part 7410.1810
OFFICE USE ONLY
If you have religious objections to complying with driver’s license and identification card image requirements, you
may petition in writing for a variance.
PS30371-02 (01/16)
List of background documents submitted:
Reasons a variance should be granted:
Background information on this request (such as previous cards issued by the department without a photo) and the
department’s treatment of similar cases, if known:
As a condition of granting a variance (failure to mark one of the boxes will result in automatic denial of the
petition):
I attest to the accuracy of the information provided in this petition.
Signature of Petitioner
Date
I agree to allow placement of my full-face image on the department record (not on the card itself).
I agree to provide a unique biometric identifier, such as fingerprints, instead of a full-face image.
First Name Middle Name Last Name
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
• Mail form with nonrefundable $10 fee to: Driver and Vehicle Services, DVS Variance Request, 445 Minnesota Street, St.
Paul, MN 55101-5183. Checks or money orders are payable to Driver and Vehicle Services. Please do not send cash.
• Additional information may be required before granting or denying this petition. You will be notified of the Department's
decision by mail within 30 days of receiving your petition.
• All information requested on this form is required by Minnesota Statutes, sections 14.055 and 14.056, or Minnesota Rules,
part 7410.1810. If incomplete, your petition will be automatically denied.
• If you have questions or need additional information, please contact DVS at (651) 215-1181.
This is a petition for variance from the requirement for the capture and/or display of a full-face image on a Minnesota driver’s
license, permit, or identification card (Minnesota Rules, part 7410.1810).
File Number
Fee Paid
Date Received
Phot og ra ph ic I ma ge o n Ca rd R eq ui re me nt
Phone Number
