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Get and Sign Ma Cdl Self Certification Faq Form 2012
(last)
ADDRESS (street)
LICENSE/PERMIT NUMBER
(first)
(middle)
(city)
DAYTIME TELEPHONE NUMBER
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)
(state)
BIRTHDATE (mm/dd/yyyy)
(zip code)
EMAIL ADDRESS (print clearly)
Please select only one of the following self-certification categories. See page two (2) of this form for category
definitions.
I certify my commercial driving is:
Non-Excepted Interstate (NI)*
I engage in Interstate commerce and must meet the federal DOT
medical card requirements
Non-Excepted Intrastate (NA)*
I...
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