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Get IL DAH H 67 2016

Ield, IL 62756 217-782-2192 www.cyberdriveillinois.com YOU MUST ANSWER THESE QUESTIONS: 1. What type of permit (s) are you requesting? n Employment n Medical n Support n Educational n Family Education n Day Care n BAIID Required RDP 2. List the vehicle(s) (make, model, year) in which you will install the BAIID. Circle the vehicle(s) that you own. 3. How many other drivers are in your household? Give names, ages and relationships. 4. Do you take any prescription medications? If so, please.

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