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Get Fl Hsmv 72077 2010

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF DRIVER LICENSES Release From Incarceration Form Name Street Address Sex Date of Birth Driver License Number Violation Incarceration Date Release Date Agency Address of Agency Name and Title of Person Signing Release Signature of Person Signing Telephone Number of Person Signing Name of Person in Charge of Correctional Facility For D. H. S.M. V. Use Only Date Mailed or Faxed to D. H. S.M. V Examiner s Name Office Number Department of Highway Safety and Motor Vehicles Neil Kirkman Building Room B260-F Mail Stop 87 2900 Apalachee Parkway Tallahassee Florida 32399-0580 Fax Number 850 617-5178 HSMV Form 72077 Rev 07/10. STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF DRIVER LICENSES Release From Incarceration Form Name Street Address Sex Date of Birth Driver License Number Violation Incarceration Date Release Date Agency Address of Agency Name and Title of Person Signing Release Signature of Person Signing Telephone Number of Person Signing Name of Person in Charge of Correctional Facility For D. H. S*M. V. Use Only Date Mailed or Faxed to D. H. S*M. V Examiner s Name Office Number Department of Highway Safety and Motor Vehicles Neil Kirkman Building Room B260-F Mail Stop 87 2900 Apalachee Parkway Tallahassee Florida 32399-0580 Fax Number 850 617-5178 HSMV Form 72077 Rev 07/10. .

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