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Get Nm Mvd Medical Report Form

Microfilm Number Line DIVISION USE ONLY MVD - 10124 REV. 09/01 State of New Mexico MOTOR VEHICLE DIVISION Field Office Number What was issued q License q Permit MEDICAL REPORT PLEASE BE ADVISED THAT THE DECISION TO ALLOW APPLICANT TO CONTINUE TO RETAIN HIS/HER NEW MEXICO DRIVER S LICENSE IS CONTINGENT UPON THE INFORMATION PROVIDED IN THIS MEDICAL REPORT.

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