Motor Vehicle Driver’s Certification of Violations

List your name AS SHOWN on your Driver License
Full Name(Required)
Have you had any violations in the past 12 months.(Required)
I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months. (List date/s, Offenses/s Location/s. Type of Vehicle/s)
Have you been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months.(Required)
I certify that the following is a true and complete list of convictions, forfeited bonds, or collateral during the past 12 months. (List date/s, Offenses/s Location/s. Type of Vehicle/s)
MM slash DD slash YYYY
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