Free Voluntary Temporary Surrender of License - Wisconsin


File Size: 23.5 kB
Pages: 1
Date: January 16, 2008
File Format: PDF
State: Wisconsin
Category: Government
Author: WisDOT
Word Count: 217 Words, 1,376 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.dot.wisconsin.gov/drivers/forms/mv3581.pdf

Download Voluntary Temporary Surrender of License ( 23.5 kB)


Preview Voluntary Temporary Surrender of License
VOLUNTARY TEMPORARY SURRENDER OF LICENSE
Wisconsin Department of Transportation MV3581 12/2007 s.343.265(1m) Wis. Stats.

Clear form

I volunteer to temporarily surrender my license, classes, or endorsements because of: CLS - Class(es) & Endorsement or Insurance premiums EDT - Endorsement Only INS - Financial responsibility only, SR22 RLP - Medical reason is: ________________________

Social Security Number - For Identification Purposes

Driver License Number

Check one:

License attached License lost or destroyed

Circle all classes and/or endorsements affected by the voluntary temporary surrender: Classes: A B C D M Endorsements: F H N P S T

If you wish to temporarily surrender your license, you MUST sign and date this form.

X
(Driver Signature) (Date)

Print

During the time your license is surrendered, you are NOT permitted to drive vehicles that require the classes and/or endorsements surrendered. If not all classes and/or endorsements are surrendered, contact a DMV service center to complete an application and pay a duplicate fee to obtain a license reflecting the remaining classes and/or endorsements. When you are eligible for licensing of the surrendered classes and/or endorsements, a duplicate or renewal license will be required. If you have Power of Attorney OR guardianship of driver, you must provide a copy of the court document for proof.