Form HSMV 71143 at a glance
What it is: Form HSMV 71143 is the Certification of Driving Experience of a Minor from the State of Florida Department of Highway Safety and Motor Vehicles.
Notary: All signatures must be notarized or witnessed by an examiner.
One parent, legal guardian, or other responsible adult 21 years old or older must sign this form.
A filled-in Form HSMV 71143 example: a mother certifies her son's driving hours
How to fill out Form HSMV 71143, box by box
The minor
After "I do hereby certify that", enter First, Middle and Last for a minor.
Enter the date of birth. Certified: a minor has driven a minimum of 50 hours during the past 12 months, of which 10 hours of driving were at night per Section 322.05(3), Florida Statutes.
Signature of Parent, Legal Guardian or Responsible Adult
Sign on the Signature of Parent, Legal Guardian or Responsible Adult line and enter the Print Name.
Notary public or DL examiner
Enter the COUNTY OF, then the day after "Sworn to (or affirmed) and subscribed before me this".
After "by", enter the person who is personally known to me or produced identification, then the Identification type and number as proof of identification.
Sign on the Notary Public or DL Examiner-Signature line, and print, type or stamp the Commissioned Name of Notary Public.
Sources
[1] Form HSMV 71143 (Rev 01/11), Certification of Driving Experience of a Minor, Florida Department of Highway Safety and Motor Vehicles (the Official source link on this page).