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Get IL DSD CDTS 57.3 2013

Tment Driving Instructor Physical Form Instructor/Applicant Name: Describe any history of Epilepsy, Heart Disease or Fainting Spells: Heart Blood Pressure Pulse Rate Respiratory System Reflexes Genito Urinary System Urine Does Applicant have the normal use of both (answer yes or no ; describe under remarks) Arms Hands Legs Feet Eyes Mental Alertness (observation) Hearing Hearing Results Deaf Poor Fair Good Both.

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