Form PS31086 "Special Review Awareness Form" - Minnesota

What Is Form PS31086?

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 February 1, 2010;
  • 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 PS31086 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 PS31086 "Special Review Awareness Form" - Minnesota

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Print Form
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
Spec ia l Rev iew Awareness
Print and mail, or return in person, this completed application to Driver and Vehicle Services, 445 Minnesota Street - Suite
170, St. Paul, Minnesota 55101-5170. It may also be faxed to (651) 282-2463.
If you have questions or need additional information, please contact DVS at (651) 296-2025.
Minnesota Rule 7503.1250 requires individuals with multiple alcohol and/or controlled substance offenses on their driving
record to complete and return the following notice, in addition to meeting all other reinstatement requirements.
You may not drive until you receive a reinstatement notice!
DL Number (
)
Driver's Date of Birth
OMIT DASHES
(mm/dd/yy)
PRINT OR TYPE:
I,
Name (
)
FIRST, MIDDLE, LAST
understand that any alcohol or controlled substances-related incident, not currently a part of my Minnesota driving
record, may result in the cancelation and denial of all driving privileges (including limited privileges for work) in the
State of Minnesota.
X
Signature
Date
(mm/dd/yy)
Witnessed by:
Subscribed and sworn to before me this
day of _______ 20 _____
NOTARY PUBLIC ______________________________________
COUNTY:____________________________
MY COMMISSION EXPIRES_____________
Witness may be a representative of the Department of Public Safety or a Notary
Public.
PS31086-05 (2/10)
Print Form
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
Spec ia l Rev iew Awareness
Print and mail, or return in person, this completed application to Driver and Vehicle Services, 445 Minnesota Street - Suite
170, St. Paul, Minnesota 55101-5170. It may also be faxed to (651) 282-2463.
If you have questions or need additional information, please contact DVS at (651) 296-2025.
Minnesota Rule 7503.1250 requires individuals with multiple alcohol and/or controlled substance offenses on their driving
record to complete and return the following notice, in addition to meeting all other reinstatement requirements.
You may not drive until you receive a reinstatement notice!
DL Number (
)
Driver's Date of Birth
OMIT DASHES
(mm/dd/yy)
PRINT OR TYPE:
I,
Name (
)
FIRST, MIDDLE, LAST
understand that any alcohol or controlled substances-related incident, not currently a part of my Minnesota driving
record, may result in the cancelation and denial of all driving privileges (including limited privileges for work) in the
State of Minnesota.
X
Signature
Date
(mm/dd/yy)
Witnessed by:
Subscribed and sworn to before me this
day of _______ 20 _____
NOTARY PUBLIC ______________________________________
COUNTY:____________________________
MY COMMISSION EXPIRES_____________
Witness may be a representative of the Department of Public Safety or a Notary
Public.
PS31086-05 (2/10)