Form TC 94-182 template
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This document is a Medical Review Affidavit form used in Kentucky for reporting drivers believed to be incapable of safely operating a motor vehicle due to physical or mental conditions. The form must include notarized signatures of at least two citizens, except for certain authorized individuals and entities. Section 1 requires driver information, including name, license number, date of birth, and address. Section 2 requires reporting individual information, including their title and contact details. The reason for believing the driver is incapable of safe driving must be explained in detail, including any witnessed unsafe driving behavior, known conditions affecting driving, and incidents leading to the report.
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