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Form 433 (Rev. 0 8/28/2018) alaska.gov/dmv STATE OF ALASKA DIVISION OF MOTOR VEHICLES PARENT/GUARDIAN CONSENT FOR A MINOR Pursuant to Alaska Statute 28.15.071, an application for a person under the age of 18 must be signed by a parent or legal guardian. The person who authorizes issuance of the l icense or permit is liable for damages caused by the minor when driving a motor vehicle. You may file a written request to cancel the license or permit. The above applies until the minor reaches 18 years of age. Please complete in ink: I, , hereby giv e my consent for Parent’s / Guardian’s Name whose date of birth is to obtain: Applicant’s Name SELECT ONLY ONE AGE Alaska Driver’s Instruction Permit (Class IP) ......................................................................................................... (14 - 17) Alaska Provisional Driver’s License (Class D)* ..................................................................................................... (16 - 17) Alaska Driver’s License (Class D)** ........................................................................................................................ (16 - 17) Alaska ATV & Snowmachine Driver’s License (Class R)*** .................................................................................. (16 - 17) * Must have held a valid permit for the class of license applying for (IP for D or IM for M1) for at least 6 months with no violations. ** Must have held a valid Provisional license (D or M1) for 6 months with no violations or repeat minor consuming offense. *** Must only operate on public roads in communities that allow operation through a local ordinance that conforms to AS 28.01.010(a). NOTE : If applying for a motorcycle permit/license use Form 433M - Parent/Guardian Consent For A Minor For A Motor Driven Cycle I agree to assume full financial responsibility for this individual until his/her 18 th birthday. I understand that I may file a request to cancel the license/permit at any time. To obtain a Provisional License, I certify that the applicant has had at least 10 hours of driving experience in inclement weather (snow, ice, rain, darkness, etc.) for a total of 40 hours driving experience. Parents Driv er’s License #: Issuing State: Your Relationship to Applicant: Your Mailing Address: Email Phone Signature: Sworn and subscribed before me this ____________ day of _________, 20 Notary Public or DMV Representative ( LOGIN ID & Office Nu mber) AMVC________ / Office # ________ My Commission Expires: Provisional License Information and Restrictions A person under the age of 18 is required to have a provisional license for a minimum of six (6) months before a regular license can be issu ed. The provisional license must be the same class as the regular license you are applying for. (D or M1) The applicant cannot have been convicted of a traffic law in the six months prior to application. The following restrictions apply to a provisiona l license: 1) Applicant may not carry passengers under the age of 21, with the exception of siblings or a legal guardian. 2) May not operate a motor vehicle between 1:00 a.m. and 5:00 a.m., unless: • accompanied by a licensed driver age 21 or above. • driving to or from their place of employment along the most direct route. To obtain a regular license, the applicant cannot have been convicted of a traffic law or repeat minor consuming revocation in the six (6) months prior to application for a regular license. Notes: Passenger and curfew hours do not apply to a license with an off -highway restriction. When the driver reaches age 18, the restrictions for the provisional license no longer apply. Obtaining a regular license is optional. If parent not present at DMV for m must have the parents signature notarized. 433