Form HSMV71142C "Caregiver of a Minor, Not a Parent or Legal Guardian, for a Driver Application of a Minor" - Florida

What Is Form HSMV71142C?

This is a legal form that was released by the Florida Department of Highway Safety and Motor Vehicles - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the Florida Department of Highway Safety and Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form HSMV71142C by clicking the link below or browse more documents and templates provided by the Florida Department of Highway Safety and Motor Vehicles.

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Download Form HSMV71142C "Caregiver of a Minor, Not a Parent or Legal Guardian, for a Driver Application of a Minor" - Florida

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STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
Caregiver of a Minor, not a Parent or Legal Guardian,
FOR A DRIVER APPLICATION OF A MINOR
I do hereby consent that
, a minor, date of birth
First
Middle
Last
be granted a Florida driver license. I may withdraw this consent by notifying the Department in writing.
Signature of Caregiver, NOT a Parent or Legal Guardian
Print Name
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me this
day of
, 20
,
by
who is personally known to me or produced Identification
as proof of identification.
(Identification type and number)
Notary Public or DL Examiner-Signature
Print, Type, or Stamp Commissioned Name of Notary Public
INSTRUCTIONS:
1. One caregiver must sign this form.
2. All signatures must be notarized or witnessed by an examiner
3. Present this form, a social security card (if you have been issued one), and proof of identity satisfactory to the
Department of Highway Safety and Motor Vehicles. This form is not required if married.
A RESPONSIBLE ADULT (21 YEARS OF AGE OR OLDER) MUST ACCOMPANY A DRIVER
HOLDING A LEARNER’S LICENSE
Drivers under 18 years of age must meet the following criteria before they are eligible to apply for a Class E License:
Hold a Learner’s License for a minimum of 12 months.
No traffic convictions 12 months prior to making a Class E application, or
One non-criminal traffic conviction where an election to complete a basic driver improvement course wherein the
points were not assessed by the clerk of court (adjudication withheld).
Parent, legal guardian or other responsible adult 21 years of age or older must certify in person or by notary that the
applicant has completed 50 hours of behind the wheel experience, of which 10 hours was night-time driving.
HSMV 71142C (Rev 06/18)
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
Caregiver of a Minor, not a Parent or Legal Guardian,
FOR A DRIVER APPLICATION OF A MINOR
I do hereby consent that
, a minor, date of birth
First
Middle
Last
be granted a Florida driver license. I may withdraw this consent by notifying the Department in writing.
Signature of Caregiver, NOT a Parent or Legal Guardian
Print Name
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me this
day of
, 20
,
by
who is personally known to me or produced Identification
as proof of identification.
(Identification type and number)
Notary Public or DL Examiner-Signature
Print, Type, or Stamp Commissioned Name of Notary Public
INSTRUCTIONS:
1. One caregiver must sign this form.
2. All signatures must be notarized or witnessed by an examiner
3. Present this form, a social security card (if you have been issued one), and proof of identity satisfactory to the
Department of Highway Safety and Motor Vehicles. This form is not required if married.
A RESPONSIBLE ADULT (21 YEARS OF AGE OR OLDER) MUST ACCOMPANY A DRIVER
HOLDING A LEARNER’S LICENSE
Drivers under 18 years of age must meet the following criteria before they are eligible to apply for a Class E License:
Hold a Learner’s License for a minimum of 12 months.
No traffic convictions 12 months prior to making a Class E application, or
One non-criminal traffic conviction where an election to complete a basic driver improvement course wherein the
points were not assessed by the clerk of court (adjudication withheld).
Parent, legal guardian or other responsible adult 21 years of age or older must certify in person or by notary that the
applicant has completed 50 hours of behind the wheel experience, of which 10 hours was night-time driving.
HSMV 71142C (Rev 06/18)