Farm Work License Affidavit
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
445 Minnesota Street
Saint Paul, MN 55101-5170
Phone: (651) 296-2025 Fax: (651) 282-2463
Web: dvs.dps.mn.gov
Give this completed form to the examiner at the time of your road test. After you complete your road test, submit the
form at the time of license application. Call 651-297-2005 or 651-282-6555 (TTY) for locations.
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If you have questions or need additional information, please contact DVS at 651-297-3298 or 651-282-6555 (TTY).
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This information is collected by authority of Minnesota Statutes 171.041.
STATE OF MINNESOTA )
SS
COUNTY OF )
, being first duly sworn, says that he/she is
the parent or legally-appointed guardian of
,
who was born on , . That he/she is making this affidavit for the
purposes of verifying the necessity for the issuance of a restricted farm work driver’s license to the said child.
Affiant further states that driving by the said child is necessary to assist affiant in the performance of
farm work on the family operated farm.
Parent/Guardian Signature
Witnessed by:
Subscribed and sworn to before me this ___________ day of _______ 20 _____
COUNTY ____________________________
MY COMMISSION EXPIRES _____________
Witness may be a representative of the Department
of Public Safety or a Notary Public.
NOTARY PUBLIC ______________________________________
PS30188-6 (07/2019)
Affiant further states that he/she knows and understands that such restricted farm work license will be
issued and be valid for the purpose of authorizing the said child to assist his/her parent or guardian with farm
work on the family operated farm, and additionally the individual may perform farm work under the restricted
license for any entity authorized to farm under section 500.24; that he/she knows and understands that said
child, if issued a restricted farm work license, may operate a motor vehicle only during the hours of daylight
within a radius of 40 miles of affiant's farmhouse and that violation of these restrictions may result in the
suspension or revocation of the child's driving privileges.
