Fillable how do you get a seat belt exemption in maine form

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MAINE BUREAU OF MOTOR VEHICLES APPLICATION FOR SEAT BELT EXEMPTION ___ New Application ___ Re-Application ___ Replacement BMV Use Only Placard #: ___ Issue Date: ___ Exp Date: ___ Returned #: ___ Replaced #: ___ Issued By: ___ Entered: ___ Applicant's Name:___ Address: ___ ___ Daytime
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