Form HSMV71144 "Parent Proctoring of on-Line Driver License Testing by a Minor" - Florida

Form HSMV71144 is a Florida Department of Highway Safety and Motor Vehicles form also known as the "Parent Proctoring Of On-line Driver License Testing By A Minor". The latest edition of the form was released in March 1, 2015 and is available for digital filing.

Download an up-to-date Form HSMV71144 in PDF-format down below or look it up on the Florida Department of Highway Safety and Motor Vehicles Forms website.

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Download Form HSMV71144 "Parent Proctoring of on-Line Driver License Testing by a Minor" - Florida

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STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
PARENT PROCTORING OF ON-LINE DRIVER LICENSE TESTING BY A MINOR
I do hereby affirm that I was present when the State of Florida knowledge test for a Class E Learner’s License
was completed on-line by my child or ward______________________________________________, a minor,
First
Middle
Last
date of birth _________________________.
I attest from my own observation that the named applicant responded to the items on the Class E Knowledge
test without reference to other materials and without assistance from another person, including myself.
Printed name of Parent or Legal Guardian:
Signature of Parent or Legal Guardian:
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.
(Identification type and number)
_____________________________________________________
Notary Public or DL Examiner/Agent-Signature
_____________________________________________________
Print, Type, or Stamp Commissioned Name of Notary Public
INSTRUCTIONS:
1. The parent or legal guardian of the on-line tested applicant must sign this form.
2. All signatures must be notarized or witnessed by an examiner.
HSMV 71144 (Rev 03/15)
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
PARENT PROCTORING OF ON-LINE DRIVER LICENSE TESTING BY A MINOR
I do hereby affirm that I was present when the State of Florida knowledge test for a Class E Learner’s License
was completed on-line by my child or ward______________________________________________, a minor,
First
Middle
Last
date of birth _________________________.
I attest from my own observation that the named applicant responded to the items on the Class E Knowledge
test without reference to other materials and without assistance from another person, including myself.
Printed name of Parent or Legal Guardian:
Signature of Parent or Legal Guardian:
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.
(Identification type and number)
_____________________________________________________
Notary Public or DL Examiner/Agent-Signature
_____________________________________________________
Print, Type, or Stamp Commissioned Name of Notary Public
INSTRUCTIONS:
1. The parent or legal guardian of the on-line tested applicant must sign this form.
2. All signatures must be notarized or witnessed by an examiner.
HSMV 71144 (Rev 03/15)
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