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Get FL HSMV 72077 2015

E: Street Address: Sex: Date of Birth: Driver License Number: Violation: Violation Date: Incarceration Date: Release Date: Agency: Address of Agency: Name and Title of Person Signing Release: Signature of Person Signing Release: Telephone Number of Person Signing: Release: Name of Person in Charge of Correctional Facility: Telephone Number of Person in Charge of Facility: (For D.H.S.M.V. Use Only) Date Mailed or Faxed to D.H.S.M.V: Examiner’s Name: Office Number: Department of Highway .

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