391.27—Record of violations.

Driver's Certification
I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months.
Date of convictionOffense
LocationType of motor vehicle operated
If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months.
(Date of certification) (Driver's signature)
(Motor carrier's name)
(Motor carrier's address)
(Reviewed by: Signature) (Title)
[35 FR 6460, Apr. 22, 1970, as amended at 35 FR 17420, Nov. 13, 1970; 52 FR 20589, June 1, 1987; 60 FR 38745, July 28, 1995]