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CDL Medical Self-Certification Form

State of Maine Secretary of State Bureau of Motor Vehicles CDL Compliance Unit MVE 64C Revised 7/15 CDL Medical Self-Certification Form Name of Driver: ME Lic #: (Please print) I certify that I meet the following Medical requirements contained in Section 391 of the Federal Motor Carrier Safety Regulations (FMCSR). Please check only one of the following Self-Certification driving types that apply to you. Non-excepted Interstate: I operate or expect to operate in interstate commerce. I am subject to and meet the Medical qualification requirements in FMCSR section 391 and required to obtain a Medical examiner s certificate.

controlled and operated by a person engaged in custom-harvesting operations, if the commercial motor vehicle is used to- Transport farm machinery, supplies, or both to or from a farm for custom-harvesting operations on a farm; or Transport custom-harvested crops to storage or market.

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