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SAN ANDREAS DEPARTMENT OF MOTORVEHICLE Commercial License Registration |
| Last Name: Dermawan | First Name: Agus | Date: 24/12/2024 | DOB: 15/04/2001 |
| Age: 23 | Address: ganton | Phone Number: 931794 | Nationality: russia |
Documents:
ID Card
Driving License
I understand that I am obligated to be complete and truthful in providing information on this application. I have read, understand and agree with the contents of this form, including the certifications on the back of this form. I certify under penalty of perjury under the laws of the State of California that all the information on this form is true and correct.
Los Santos, 24/12/2004
Agus Dermawan
