Letter Of Authorization (Page 3 of 3) in pdf

Box 6300

Winnipeg, MB R3C 4A4

(204) 985-7000

Driver Unavailable – Declaration of Residency

I, __________________________________, of ________________________________________________, in

(Print Name)

(Print Street Address or P.O. Box)

___________________________________________, in the Province of Manitoba do hereby state and declare that

(Print city or Town)

I am a person resident of the Province of Manitoba, that I am legally entitled to be in Canada and I live and am

ordinarily present in Manitoba, or intend to live in Manitoba on a permanent basis.

My driver’s licence number is ____________________________________________________.

(Please Print)

I AM TEMPORARILY ABSENT FROM MANITOBA BECAUSE I AM

In full time attendance in a course of study at an educational institution (university, college, technical school,

high school or other institution of learning recognized by the registrar) outside Manitoba, or

taking a sabbatical leave, or advanced or supplementary training or instruction while on educational leave from

employment, or

serving as a missionary or aid worker on behalf of a religious or nonprofit organization approved as a

registered charity under the Income Tax Act (Canada), or

employed with the Government of Manitoba, the Government of Canada, or an agency of either government,

temporarily absent from Manitoba for a period not exceeding 12 consecutive months for the purpose of

assuming a temporary employment of fulfilling a contract, or

away for the winter (Snowbird), vacation etc…________________________________________and intend

to return to and reside in Manitoba immediately after completion of the above indicated

condition/reason and reasonable travelling time.

I authorize ______________________________________________________________ to pick-up/purchase my driver’s licence.

(Print Name and Contact Telephone Number)

I MAKE THIS APPLICATION TO THE REGISTRAR OF MOTOR VEHICLES IN SUPPORT OF MY APPLICATION OF THE

RENEWAL OF MY MANITOBA DRIVER’S LICENCE.

____________________________________________ ___________________________________________________

DATE

SIGNATURE

CAUTION:

IT IS THE RESPONSIBILITY OF THE DRIVER TO ENSURE COMPLIANCE WITH THE HIGHWAY

SAFETY/LICENSING LAWS OF EACH JURISDICTION IN WHICH HE/SHE OPERATES A VEHICLE.

PLEASE CONTACT THE LOCAL LICENSING AUTHORITIES TO ENSURE THAT YOU ARE ALLOWED TO

MAINTAIN AND USE YOUR MANITOBA DRIVER’S LICENCE WHILE YOU ARE THERE.

Driver and Vehicle Licensing Box 6300 Winnipeg MB R3C 4A4

Telephone: (204) 985-7000

MISC-1174 (R-01/10)

Letter Of Authorization Page 3