Form PS33061B "Withdrawal/Reinstatement of Parental Consent" - Minnesota

What Is Form PS33061B?

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 July 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 PS33061B 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 PS33061B "Withdrawal/Reinstatement of Parental Consent" - Minnesota

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Print Form
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
W ith d ra wa l/ Re i ns t at e m e n t o f P ar en ta l C onsen t
The form can be mailed or submitted in person to Driver and Vehicle Services, 445 Minnesota St. -
Suite 170, St. Paul, Minnesota 55101-5170. It may also be faxed to 651-797-1760
• If you have questions or need additional information, please contact DVS at 651-296-2025 or
651-282-6555 (TTY).
• To ensure that this request is processed in a timely manner, please type or print legibly.
Name (
)
Date of Birth
LAST, FIRST, MIDDLE INITIAL
(mm/dd/yy)
DL Number (
)
OMIT DASHES
A Withdrawal of Parental Consent
I am requesting that Driver and Vehicle Services cancel the driving privileges of the
above-named child, who is under age 18.
B Reinstatement
I request that the driving privileges of the above-named child, who is under age 18, be
reinstated. I understand that he or she may not operate a motor vehicle until receiving
written notification from Driver and Vehicle Services that driving privileges have been
reinstated.
I have read and fully understand the procedures for canceling and reinstating the above-named child's
driving privileges. I have informed him/her that s/he may not operate a motor vehicle until receiving written
notification from Driver and Vehicle Services that his/her driving privileges have been reinstated.
I also state that I am the parent/guardian who signed the application originally granting consent to drive, or
who signed the Withdrawal of Parental Consent/Voluntary Surrender form canceling the driving privileges
of the above-named minor child.
Parent/guardian signature of above-named minor child
Date
(mm/dd/yy)
PS33061B-01 (07/16)
Print Form
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
W ith d ra wa l/ Re i ns t at e m e n t o f P ar en ta l C onsen t
The form can be mailed or submitted in person to Driver and Vehicle Services, 445 Minnesota St. -
Suite 170, St. Paul, Minnesota 55101-5170. It may also be faxed to 651-797-1760
• If you have questions or need additional information, please contact DVS at 651-296-2025 or
651-282-6555 (TTY).
• To ensure that this request is processed in a timely manner, please type or print legibly.
Name (
)
Date of Birth
LAST, FIRST, MIDDLE INITIAL
(mm/dd/yy)
DL Number (
)
OMIT DASHES
A Withdrawal of Parental Consent
I am requesting that Driver and Vehicle Services cancel the driving privileges of the
above-named child, who is under age 18.
B Reinstatement
I request that the driving privileges of the above-named child, who is under age 18, be
reinstated. I understand that he or she may not operate a motor vehicle until receiving
written notification from Driver and Vehicle Services that driving privileges have been
reinstated.
I have read and fully understand the procedures for canceling and reinstating the above-named child's
driving privileges. I have informed him/her that s/he may not operate a motor vehicle until receiving written
notification from Driver and Vehicle Services that his/her driving privileges have been reinstated.
I also state that I am the parent/guardian who signed the application originally granting consent to drive, or
who signed the Withdrawal of Parental Consent/Voluntary Surrender form canceling the driving privileges
of the above-named minor child.
Parent/guardian signature of above-named minor child
Date
(mm/dd/yy)
PS33061B-01 (07/16)