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On to Driver and Vehicle Services, 445 Minnesota Street - Ste. 170, St. Paul, Minnesota 55101-5170. It may also be faxed to 651-282-2463. This form is used to determine your eligibility for Minnesota driving privileges. Your verified statement on this form, plus a report from your doctor, is collected by the authority of Minnesota Statute 171.13 and will be used only by authorized Driver and Vehicle Services division personnel. Your doctor will need to express an opinion regarding your.

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