VOLUNTARY TEMPORARY SURRENDER OF LICENSE
Wisconsin Department of Transportation MV3581 12/2007 s.343.265(1m) Wis. Stats.
I volunteer to temporarily surrender my license, classes, or endorsements because of: CLS - Class(es) & Endorsement or Insurance premiums EDT - Endorsement Only INS - Financial responsibility only, SR22 RLP - Medical reason is: ________________________
Social Security Number - For Identification Purposes
Driver License Number
License attached License lost or destroyed
Circle all classes and/or endorsements affected by the voluntary temporary surrender: Classes: A B C D M Endorsements: F H N P S T
If you wish to temporarily surrender your license, you MUST sign and date this form.
(Driver Signature) (Date)
During the time your license is surrendered, you are NOT permitted to drive vehicles that require the classes and/or endorsements surrendered. If not all classes and/or endorsements are surrendered, contact a DMV service center to complete an application and pay a duplicate fee to obtain a license reflecting the remaining classes and/or endorsements. When you are eligible for licensing of the surrendered classes and/or endorsements, a duplicate or renewal license will be required. If you have Power of Attorney OR guardianship of driver, you must provide a copy of the court document for proof.