Form 4901 - Driver Experience Log
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1MISSOURI DEPARTMENT OF REVENUE
FORM
4901
DRIVER LICENSE BUREAU
DRIVER EXPERIENCE LOG
(REV. 10-2006)
THIS DRIVER EXPERIENCE LOG is provided, for your convenience, as a tool to help track the progress of a beginning driver. This log may be
used as verification of the required 40 hours of behind-the-wheel driving. A minimum of ten hours of behind-the-wheel driving must have occurred
during nighttime hours. The teen's parent, grandparent, legal guardian or certified instructor with a federal residential job training program must
accompany the teen to the contract office when applying for the intermediate license.
DATE
START TIME
END TIME
TOTAL TIME
TRAINER’S NAME
GRAND TOTAL
MO 860-2958 (10-2006)
DOR-4901 (10-2006)
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