Special Review Awareness
Print and mail, or return in person, this completed application to Driver and Vehicle Services, 445 Minnesota Street - Suite
170, St. Paul, Minnesota 55101-5170. It may also be faxed to (651) 282-2463.
•
If you have questions or need additional information, please contact DVS at (651) 296-2025.
•
Minnesota Rule 7503.1250 requires individuals with multiple alcohol and/or controlled substance offenses on their driving
record to complete and return the following notice, in addition to meeting all other reinstatement requirements.
•
You may not drive until you receive a reinstatement notice!
I,
DL Number (
OMIT DASHES)
Driver's Date of Birth (mm/dd/yy)
PS31086-05 (2/10)
Signature
understand that any alcohol or controlled substances-related incident, not currently a part of my Minnesota driving
record, may result in the cancelation and denial of all driving privileges (including limited privileges for work) in the
State of Minnesota.
Witnessed by:
Subscribed and sworn to before me this day of _______ 20 _____
NOTARY PUBLIC ______________________________________
COUNTY:____________________________
MY COMMISSION EXPIRES_____________
Witness may be a representative of the Department of Public Safety or a Notary
Public.
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
PRINT OR TYPE:
Name (FIRST, MIDDLE, LAST)
Date (mm/dd/yy)
X
