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Driver's License #:

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Date of Birth:
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Citation Date:
Select January February March April May June July August September October November December Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select 2016 2015 2014 2013 2012 2011 2010 2009


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