Form Dl-123 - Driver License Liability Insurance Certification

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DRIVER LICENSE LIABILITY INSURANCE CERTIFICATION
DL-123 (10/98)
Insured Driver
Date of Birth
Policyholder(s)
Insurance Company
Policy Number
Effective Date
Agency Name
Expiration Date
Agent’s Signature
Date this DL-123 Completed
(This form is valid for 30 days after completion by insurance agent)
39836

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Parent category: Legal
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