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COMPLETED BY DRIVER - CERTIFICATION OFVIOLATIONS

COMPLETED BY DRIVER - CERTIFICATION OFVIOLATIONS

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driver has been convicted, or of which he/she has forfeited bond or collateral during the preceding 12 months (49 CFR 391.27). Drivers who have provided information required by 49 CFR 383.31 need not repeat that information on this form. DRIVER REQUIREMENTS: Each driver will provide the list as required by the motor carrier above.

  Have, Bene, Convicted, Been convicted

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