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Form Hsmv 72870 - Student Compliance With Attendance Requirements For Reinstatement Of Driving Privilege/eligibility For Licensure

NOTIFICATION TO THE DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

STUDENT COMPLIANCE WITH ATTENDANCE REQUIREMENTS

FOR REINSTATEMENT OF DRIVING PRIVILEGE/ELIGIBILITY FOR LICENSURE

This is to provide verification to the Department of Highway Safety and Motor Vehicles that the

following student, who received Notice of Intent to Suspend/Withhold Eligibility for Licensure

due to non-attendance is in compliance with attendance requirements in S. 322.091(1).

Student’s Full Legal Name: _______________________________________________________

(First, Middle, Last)

Mailing Address: _______________________________________________________________

Driver License/Control Number: ____________________________Gender: ___Male___Female

Date of Birth: ______/______/______ Social Security Number: __________________________

District Name: ________________________ District Number: ___________________________

School Name: ________________________ School/Institution Number: ___________________

Date: ______/______/______

Authorized Signature of School Official: ____________________________________________

(Signature must be notarized or school seal affixed)

Title: _________________________________________________________________________

Typed or Printed Name of Person Signing Form: ______________________________________

_________________________________________

Notary Public

State of Florida at Large

___________________________________My commission expires: ______/______/_________

School Seal

Original signatures required.

For additional information contact:

Name:

___________________________Telephone:___________________________________

You may mail, fax or e-mail this completed form to: DHSMV, 2900 Apalachee Parkway, MS

#39, Tallahassee, Florida 32399-0570. The fax number is (850)-617-5095 and the e-mail

address is Truancy@flhsmv.gov. If the license is suspended, present this form to a driver

license or a tax collector’s office for reinstatement of your driving privilege. A $45

reinstatement fee is required for a suspended license.

Note: This form may only be accepted within 30 calendar days of its completion.

HSMV 72870 (07/15)

Form Hsmv 72870 - Student Compliance With Attendance Requirements For Reinstatement Of Driving Privilege/eligibility For Licensure