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