This government document is issued by Motor Vehicles for use in Louisiana
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Source
https://dpsweb.dps.louisiana.gov/DPSForms.nsf/8bad5589175b8981862575f20048ee65/ee4b2436e40a315e86256dc0006962a0/$FILE/1966%20-%20Medical%20Examiner's%20Certification%20Of%20Mobility%20Impairment%20(revised%200804).pdf
Tags
- Driver's License