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Get IN State Form 54706 2011

Reset Form LOG OF SUPERVISED DRIVING PRACTICE State Form 54706 6-11 INDIANA BUREAU OF MOTOR VEHICLES INSTRUCTIONS 1. Complete in blue or black ink or print form* 2. Must present completed form upon application for license. 3. Please attach additional sheets as necessary. SECTION 1. DRIVING LOG Driver Name Last First Middle Initial Bioptic Drivers Only - Please Check Here Driver s License Number DLN Drive Time Hours/Minutes DATE mm/dd/yyyy DAY NIGHT SECTION 2. AFFIRMATION AND SIGNATURE I certify that the driver above has completed fifty 50 hours of supervised driving practice ten 10 of which included nighttime driving practice with a licensed instructor or driver at least twenty-five 25 years of age or twenty-one 21 years of age if the spouse of the driver. Applicants eighteen 18 years of age and older do not need parent or guardian signature. I swear or affirm that the information I have entered on this form is correct. I understand that making a false statement may constitute the crime of perjury. Printed Name of Parent or Legal Guardian Signature of Parent or Legal Guardian if Applicant is under eighteen 18 years of age Signature of Driver if Driver is eighteen 18 years of age or older. Complete in blue or black ink or print form* 2. Must present completed form upon application for license. 3. Please attach additional sheets as necessary. SECTION 1. DRIVING LOG Driver Name Last First Middle Initial Bioptic Drivers Only - Please Check Here Driver s License Number DLN Drive Time Hours/Minutes DATE mm/dd/yyyy DAY NIGHT SECTION 2. 3. Please attach additional sheets as necessary. SECTION 1. DRIVING LOG Driver Name Last First Middle Initial Bioptic Drivers Only - Please Check Here Driver s License Number DLN Drive Time Hours/Minutes DATE mm/dd/yyyy DAY NIGHT SECTION 2. AFFIRMATION AND SIGNATURE I certify that the driver above has completed fifty 50 hours of supervised driving practice ten 10 of which included nighttime driving practice with a licensed instructor or driver at least twenty-five 25 years of age or twenty-one 21 years of age if the spouse of the driver. AFFIRMATION AND SIGNATURE I certify that the driver above has completed fifty 50 hours of supervised driving practice ten 10 of which included nighttime driving practice with a licensed instructor or driver at least twenty-five 25 years of age or twenty-one 21 years of age if the spouse of the driver. Applicants eighteen 18 years of age and older do not need parent or guardian signature. I swear or affirm that the information I have entered on this form is correct. Applicants eighteen 18 years of age and older do not need parent or guardian signature. I swear or affirm that the information I have entered on this form is correct. I understand that making a false statement may constitute the crime of perjury. Printed Name of Parent or Legal Guardian Signature of Parent or Legal Guardian if Applicant is under eighteen 18 years of age Signature of Driver if Driver is eighteen 18 years of age or older. .

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Keywords relevant to IN State Form 54706

  • certify
  • affirmation
  • Applicant
  • constitute
  • Applicants
  • Supervised
  • spouse
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