This government document is issued by Commission on Family Violence for use in Georgia
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https://www.google.com/url?client=internal-element-cse&cx=450907bf5042c4844&q=https://gcfv.georgia.gov/document/document/georgia-drivers-history-consent-form/download&sa=U&ved=2ahUKEwj_pb_gkcCLAxWlTeUKHRL6BSA4ChAWegQIBBAB&usg=AOvVaw1ugcAllmFDQ7UVZWyoABKh