health problems because of alcohol or drug abuse.decrease or change in your vision due to cataracts, macular degeneration, diabetic retinopathy, glaucoma, retinitis pigmentosa, or other progressive condition or.disease, disorder, or disability (examples of these are epilepsy, diabetes, stroke, cataracts, Parkinson’s disease) or.
episode of marked confusion caused by any condition which may bring about recurring lapses or.The following conditions that may affect your ability to operate a motor vehicle safely include, but are not limited to: THE FOLLOWING INFORMATION AND CERTIFICATIONS IT IS IMPORTANT THAT YOU READ AND UNDERSTAND ), Number, Street, Apt/Space No., City, State, Zip CodeĪddress Where You Live ( If different from mailing address ), Number, Street, Apt/Space No., City, State, Zip Code
Box, or Private Mail Box ( Include Box Number, St., Ave., Rd., Blvd., etc.
READ ALL INFORMATION PROVIDED ON THE FRONT AND BACK OF THIS FORM. PURPOSE FOR YOUR VISIT: 3 the appropriate box(es).
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