Get Mn Ps31125 2009

Minnesota Department of Public Safety Driver and Vehicle Services Division 445 Minnesota St. Suite 166 St. Paul MN 55101-5166 PHONE 651 297-5034 FAX 651 282-5512 TTY 651 282-6555 Internet mndriveinfo. org PS31125-11 REQUEST FOR ADMINISTRATIVE REVIEW OF LICENSE PLATE IMPOUNDMENT ORDER REQUEST TO APPROVE SALE OF VEHICLE SUBJECT TO LICENSE PLATE IMPOUNDMENT Please complete the following information Incomplete information may delay your request. Minnesota Department of Public Safety Driver and Vehicle Services Division 445 Minnesota St* Suite 166 St* Paul MN 55101-5166 PHONE 651 297-5034 FAX 651 282-5512 TTY 651 282-6555 Internet mndriveinfo. org PS31125-11 REQUEST FOR ADMINISTRATIVE REVIEW OF LICENSE PLATE IMPOUNDMENT ORDER REQUEST TO APPROVE SALE OF VEHICLE SUBJECT TO LICENSE PLATE IMPOUNDMENT Please complete the following information Incomplete information may delay your request. MAKE YEAR VEHICLE IDENTIFICATION NUMBER DRIVER S FULL NAME AT TIME OF INCIDENT IMPOUNDED PLATE NUMBER DATE OF BIRTH DRIVER S ADDRESS AT THE TIME OF INCIDENT DRIVER S LICENSE NUMBER INCIDENT DATE OWNER S OR PURCHASER S FULL NAME BY A VEHICLE OWNER WHO WAS NOT THE VIOLATOR/OPERATOR See information on back I request the plate impoundment order for the above-described vehicle be rescinded* I am the owner and possessor of the vehicle. Neither I nor any co-owners were driving nor were passengers in the vehicle at the time of the violation* I know that the violator may not drive operate or be in physical control of a vehicle without a valid driver s license. I also understand that I may petition for a Judicial Review within 30-days of the qualifying incident even if the plate impoundment order is sustained after the Administrative Review. The above listed driver obtained the vehicle from me on date Please Check One 1 At the time of the incident the violator had a valid driver s license. 2 A report was filed with law enforcement BEFORE the incident stating that the vehicle had been taken from the owner s possession or was being used without permission* Submit a copy of the police report X Signature of Vehicle Owner PURCHASER S STATEMENT Please Read sign at the X below if you agree with all the following statements. I request authorization to transfer the ownership of the above-described vehicle. I have purchased the vehicle for which I attest is valid consideration* I am not related by blood marriage or adoption to the registered owner or violator. I do not reside in the same household as the owner or violator. I have no significant relation as defined in M. S* 169A. 60 with the registered owner or violator A significant relation is defined as any person with whom the actor violator/owner regularly associates and communicates with outside of a workplace setting. My driver s license is not revoked or canceled for an alcohol or drug violation* I know that an individual may not drive operate or be in physical control of a vehicle without a valid driver s license I understand that a false or fraudulent statement is a violation of state law You have the right to request the department to conduct an administrative review of a license plate impoundment order.