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Get NEBRASKA DEPARTMENT OF MOTOR VEHICLES PO Box 94726 Lincoln, NE 68509 - Dmv Ne

To be completed by optometrist or ophthalmologist. (REQUIRED) (Applicant completes before doctor s exam.) By this form, or copy thereof, I hereby authorize and request the examining doctor to provide any information regarding my visual condition and history to the Department of Motor Vehicles, State of Nebraska. Dated: Signed: (Applicant s Signature) I hereby certify that I exami.

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