Form PS33160-03 Part 7410.0600 "Petition for a Variance of Minnesota Rules" - Minnesota

What Is Form PS33160-03 Part 7410.0600?

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

Form Details:

  • Released on January 1, 2016;
  • The latest edition provided by the Minnesota Department of Public Safety;
  • 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 PS33160-03 Part 7410.0600 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Public Safety.

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Download Form PS33160-03 Part 7410.0600 "Petition for a Variance of Minnesota Rules" - Minnesota

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OFFICE USE ONLY
Print Form
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
File Number
Fee Paid
Pet itio n fo r a V ar i a n c e o f Mi nnesota Rul es, Part 7 41 0.0 60 0
Date Received
Pri m a ry a nd Seco n dar y D oc u me nta tion R equir e me n ts
A petition for a variance provides a way for individuals to apply for a Minnesota driver's license or identification card, who
do not have and are unable to obtain identification and residency documents required under Minnesota Rules 7410.0400
(Documenting proof of name, date of birth, identity), and/or part 7410.0410 (Proof of residency).
PLEASE REFER TO THE INSTRUCTIONS ON HOW TO COMPLETE THIS FORM.
Section A
-
-
-
-
Date of Birth
Minnesota Driver's License Number (if applicable)
First Name
Middle Name
Last Name
Address
City/State/Zip
Phone Number
Section B:
Explain why you are requesting a variance
(Include reasons why you are unable to obtain documentation needed to complete your application).
Section C:
List supporting documents and additional information regarding name and identity or legal residency.
For example: Date and Place of Birth, Place of Residence, Military Service Information, Social Security Number, Immigration Information,
Marriage Certificates, School Records, any arrest information. Please list the city or county, along with the state where your birth or marriage
occured.
I attest to the accuracy of the information provided in this petition for variance from Minnesota Rules, parts 7410.0400 and/or
7410.0410.
X
Signature
Date
(mm/dd/yy)
- over -
PS33160-03 (01/16)
OFFICE USE ONLY
Print Form
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
File Number
Fee Paid
Pet itio n fo r a V ar i a n c e o f Mi nnesota Rul es, Part 7 41 0.0 60 0
Date Received
Pri m a ry a nd Seco n dar y D oc u me nta tion R equir e me n ts
A petition for a variance provides a way for individuals to apply for a Minnesota driver's license or identification card, who
do not have and are unable to obtain identification and residency documents required under Minnesota Rules 7410.0400
(Documenting proof of name, date of birth, identity), and/or part 7410.0410 (Proof of residency).
PLEASE REFER TO THE INSTRUCTIONS ON HOW TO COMPLETE THIS FORM.
Section A
-
-
-
-
Date of Birth
Minnesota Driver's License Number (if applicable)
First Name
Middle Name
Last Name
Address
City/State/Zip
Phone Number
Section B:
Explain why you are requesting a variance
(Include reasons why you are unable to obtain documentation needed to complete your application).
Section C:
List supporting documents and additional information regarding name and identity or legal residency.
For example: Date and Place of Birth, Place of Residence, Military Service Information, Social Security Number, Immigration Information,
Marriage Certificates, School Records, any arrest information. Please list the city or county, along with the state where your birth or marriage
occured.
I attest to the accuracy of the information provided in this petition for variance from Minnesota Rules, parts 7410.0400 and/or
7410.0410.
X
Signature
Date
(mm/dd/yy)
- over -
PS33160-03 (01/16)
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
INSTRUCTIONS TO COMPLETE PETITION FOR VARIANCE FORM
Provide your full legal name and residence address in Section A. If you have previously had a Minnesota driver's
Step 1
license or identification card, please include the number in Section A.
Explain why you are requesting a variance. Include reasons why you are unable to obtain a primary and secondary
Step 2
identity document as required under Minnesota Rules (7410.0100 to 7410.0600) in Section B. Attach additional pages if
needed.
List supporting documents and additional information regarding name and identity or legal residency. For birth and
Step 3
marriage certificates, please list the county or city along with state where the birth or marriage took place. Please
list this information on your variance petition form even if you are not submitting a birth or marriage certificate
with your petition (Section C).
Attach readable photocopies of all supporting documents.
(For example: documents showing: date and place of birth, military service information, social security number,
immigration information, marriage certificates, school records or any arrest information).
Mail form with nonrefundable $10 fee to:
Step 4
Driver and Vehicle Services, DVS Variance Request, 445 Minnesota Street, St. Paul, MN 55101-5183.
Checks or money orders are payable to: Driver and Vehicle Services. Please do not send cash.
All information requested on this form is required by Minnesota Statutes, sections 14.055 and 14.056, or Minnesota Rules,
part 7410.1810. If incomplete, your petition will be automatically denied.
If you have questions or need additional information, please contact DVS at (651) 215-1181.
Note: Most identity documents can be obtained from the initiating city, county, state and federal jurisdictions. A reasonable attempt
should be made to obtain documents from these jurisdictions before submitting a petition for a variance. If you are unable to obtain
documents from these authorities please provide documentation from the jurisdiction stating that the documents are not available.
Proof of Residency
Proof of residency is required. You must live in Minnesota and demonstrate proof of either lawful short-term admission to the
United States, permanent United States resident status, indefinite authorized presence status, or United States citizenship.
Documents not sufficient to prove residency. A driver's license, permit, or identification card from another jurisdiction or
another United States state is not acceptable as proof of permanent United States resident status, indefinite authorized presence
status, lawful short-term admission to the United States, or United States citizenship.
Documents sufficient to prove residency. To demonstrate permanent United States resident status, indefinite authorized
presence status, lawful short-term admission to the United States, or United States citizenship, you must present a document
specified in part 7410.0400, subpart 1 or 2 (see Identification Requirements List - Primary Documents).
If the document presented to demonstrate lawful short-term admission does not indicate a date that the admission period ends or
if the date has been extended, you must present additional documentation issued under the authority of the United States
Department of Justice or the United States Department of Homeland Security that indicates the duration of your lawful short-term
admission status.
Lawful short-term admission status. If the lawful admission period indicated on your federal primary document presented
expires in 30 days or more from the date of application you will be issued a driver's license, permit, or identification card with a
status check date that coincides with the lawful admission period on the federal primary document presented.
If the lawful admission period expires in less than 30 days from the date of application you will not receive a driver's license,
permit, or identification card. Instead a receipt for your application will be issued.
No lawful admission status. The department will not issue a driver's license, permit, or identification card if you do not have
lawful admission status to the United States.
- over -
PS33160-03 (01/16)
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
Reissuance. A driver's license, permit, or identification card shall be reissued with a new status check date if you present an
employment authorization card (I-688B, I-766 series) or notice of action (I-797A series) issued by the United States Department
of Justice or the United States Department of Homeland Security to indicate extension of the lawful admission period.
If you present an accepted application from the United States Department of Justice or the United States Department of
Homeland Security for an extension of or change in the federal lawful admission period, the driver's license, permit, or
identification card will be reissued with a status check date extension of six months from the date of the federal receipt for the
extension or change.
The state document will be reissued for a second six-month period if you present a subsequent federal document or
information indicating a decision by the federal government on the extension or change of status is still pending. After one year,
any extension request shall be handled through a request for a variance under part 7410.0600.
If you present a subsequent federal document indicating permanent United States resident status, indefinite authorized
presence status, or United States citizenship, a driver's license permit, or identification card will be reissued without a status
check date.
Documenting Proof of Name, Date of Birth and Identity
If you cannot present one primary document and one secondary document as proof of full name, date of birth, and identity (See
Identification Requirements List) you may provide other documentation for review. (For example: documentation showing; date
and place of birth, place of residence, military service information, social security number, immigration information, marriage
certificates, school records, or any arrest information.)
Full name required. Your full name is required on your driver's license, permit, or identification card.
“Full name” means: an individual's first name, one or more middle names if listed on the primary document, and one or more
last names as they appear on a primary document.
Evidence required for name change. If you have changed your legal full name as it appears on the presented primary
document you must also present legal name change documents.
To verify the name change, you must present one of the following documents:
(1)
A copy of the applicant's certificate of marriage certified by the issuing government jurisdiction;
(2)
A certified copy of a court order specifying the name change; or
(3)
A certified copy of a divorce decree or dissolution of marriage granted the applicant that specifies the name changes
requested from a court of competent jurisdiction.
PS33160-03 (01/16)
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