FAILURE TO MARK APPROPRIATE BOXES WILL RESULT IN DENIAL BY THE DEPARTMENT UNTIL A CORRECTED COURT ORDER IS RECEIVED Court Findings (must be recorded): AND (all below must be true to waive requirement) (mark all that a p p l y ) (must list below) Information below must also be completed on all other convictions requiring geographic restrictions. Furnish complete name and address (street #, street name, city & state) of each location being requested. If you have geographic restrictions, these are the ONLY locations and/or dates/times you will be authorized to operate a motor vehicle. Your correct home address should appear on your restricted driver license. American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com