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Drivers License And Identification Card Application DL1P - Virginia
| Drivers License And Identification Card Application Form. This is a Virginia form and can be used in Department Of Motor Vehicles Statewide . |
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Completion of this section is requested but not required to apply for a driver's license or ID Card. (Virginia Code §2.2-3806) INFORMATION FOR THE STATE BOARD OF ELECTIONS Are you a citizen of the United States of America? Do you want to apply to register to vote or change your voter registration address? YES (INITIAL BOX) NO (INITIAL BOX) YES (INITIAL BOX) NO (INITIAL BOX) INFORMATION FOR THE VIRGINIA TRANSPLANT COUNCIL Yes, I would like to remain or become an organ, eye and tissue donor. DL 1P (07/10/2012) R DRIVER'S LICENSE AND IDENTIFICATION CARD APPLICATION Purpose: Instructions: LOG # Use this form to apply for a Virginia Driver's License or Identification Card. Complete the front and back of this application. Note: Effective July 1, 2011, a $5 service fee applies to each license or ID card renewal transaction conducted in a CSC, unless the renewal is conducted with another transaction that cannot be completed by internet, automated telephone or mail. Note: Va. Code §§46.2-323 and 46.2-342 require that you provide DMV with the information on this form (including your social security number). It is not necessary to provide a social security number for an identification card. This social security number is for record keeping purposes and may be disseminated only in accordance with Va. Code §§46.2-208 and 46.2-209. Persons convicted of certain sexual offenses (as listed in Va. Code §9.1-902) must register or re-register with the Virginia Department of State Police as provided in Va. Code §§9.1-901, 9.1-903, and 9.1-904. If you provide a non-Virginia residence/home address or non-Virginia mailing address, your application for a driver's license or identification (ID) card may be denied. APPLICATION TYPE (Check one) 1. 5. 8. 10. Driver's License 2. Learner's Permit and Driver's License 6. 3. CDL Instruction Permit or License 7. 9. 4. Motorcycle Learner's Permit Driver's License with Motorcycle (Class M) CDL with Motorcycle (Class M) 12. Motorcycle Only Driver's License Driver's License Testing for Foreign Diplomats Driver's License with School Bus Endorsement (to carry less than 16 passengers Identification (ID) Card 11. Hearing Impaired ID Card Emancipated Minor ID Card If you are applying for a replacement license or identification card check one of the following: I am surrendering my current license or identification card. I hereby certify any current license or ID card is unavailable for surrender because it is Lost Stolen Destroyed or Mutilated Yes No Do you currently have or have you ever held a driver's license or learner's permit from Virginia, another state, U.S. territory or foreign country? If yes, provide the following: LICENSE NUMBER ISSUE DATE (mm/dd/yyyy) EXPIRATION DATE (mm/dd/yyyy) STATE/COUNTRY APPLICANT INFORMATION NOTE: YOUR ADDRESS BELOW MUST BE CURRENT. THE U.S. POSTAL SERVICE WILL NOT FORWARD. SOCIAL SECURITY NUMBER BIRTHDATE (mm/dd/yyyy) WEIGHT LBS. APT NO. CITY NAME OF CITY OR COUNTY OF RESIDENCE CITY COUNTY OF CITY STATE ZIP CODE HEIGHT FT. IN. STATE ZIP CODE EYE COLOR HAIR COLOR FULL LEGAL NAME (last, first, middle, suffix) DAYTIME TELEPHONE NUMBER GENDER (check one) MALE FEMALE ( ) STREET ADDRESS IF YOUR NAME HAS CHANGED, PRINT YOUR FORMER NAME HERE MAILING ADDRESS (if different from above - this address will show on your license/ID card) APT NO. 1. 2. 3. 4. 5. 6. Do you wear glasses or contact lenses? Do you have a physical or mental condition which requires that you take medication? Have you ever had a seizure, blackout, or loss of consciousness? Do you have a physical condition which requires you to use special equipment in order to drive? Have you been convicted within the past ten years in this state or elsewhere of any offense resulting from your operation of, or involving, a motor vehicle? (Do not include parking tickets.) Has your license or privilege to drive ever been suspended, revoked, or disqualified in this state or elsewhere, or is it currently suspended, revoked or disqualified? YES YES YES YES YES NO NO NO NO NO SPECIAL INDICATOR REQUEST I am insulin-dependent or have a speech or hearing impairment and want the following indicator(s) to show on my license ; Insulin-dependent diabetic Speech impairment Hearing impairment Submit required physician statement with this application YES NO If you answered YES to any of the above provide an explanation here. FOR DMV USE ONLY -- DO NOT WRITE BELOW THIS LINE REQUIRED TESTS VISION DL ROAD SIGNS EXAM DL KNOWLEDGE EXAM DL SKILLS PROOF OF RESIDENCY (specify) PROOF OF ID (primary) CSR SIGNATURE AND NUMBER PROOF OF LEGAL PRESENCE (specify) PROOF OF ID (secondary) DOCUMENT VERIFIER SIGNATURE AND NUMBER FEE TRANSACTION TYPE ORIGINAL REISSUE DUPLICATE RENEWAL PASS FAIL REMARKS/PAID STAMP CUSTOMER NUMBER PROOF OF SOCIAL SECURITY NUMBER (specify) American LegalNet, Inc. www.FormsWorkFlow.com DL 1P (07/10/2012) R page 2 PARENT OR GUARDIAN CONSENT FOR APPLICANTS UNDER 18 (Unless applicant is married - marriage certificate required) I authorize issuance of a learner's permit/driver's license/identification card. I certify that the applicant is a resident of Virginia. I certify that the applicant is attending school regularly and is in good academic standing, but if not, I authorize issuance of a learner's permit/driver's license. I certify that this applicant will operate a motor vehicle for at least 45 hours (15 of which will occur after sunset) while holding a learner's permit. If my child attends public school, I authorize the principal or designee of the public school attended by the applicant to notify the juvenile and domestic relations district court (within whose jurisdiction the applicant resides) when the applicant has had 10 or more unexcused absences from school on consecutive school days. I certify that the statements made and the information submitted by me regarding this certification are true and correct. PARENT/GUARDIAN NAME (print) PARENT/GUARDIAN SIGNATURE DATE (mm/dd/yyyy) YES NO APPLICANT UNDER AGE 18 Have you ever been found not innocent of any offense in a Juvenile and Domestic Relations Court in this or any other state? If you answered YES, a court within your jurisdiction must provide court consent below. COURT CONSENT In my opinion the applicant's request for a learner's permit/driver's license Remarks: should be granted. should not be granted. JUDGE NAME (print) JUDGE SIGNATURE DATE (mm/dd/yyyy) COMMERCIAL DRIVER'S LICENSE/INSTRUCTION PERMIT APPLICANTS (Check the box for the qu
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