Transcription of ACKNOWLEDGMENT OF SUSPENSION/ …
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ACKNOWLEDGMENT OF SUSPENSION/ …
DL-16LC (7-10). ACKNOWLEDGMENT OF suspension /. REVOCATION/DISQUALIFICATION/cancellation AS REQUIRED UNDER SECTION 1541 OF THE VEHICLE CODE. Bureau of Driver Licensing PLEASE TYPE OR PRINT IN blue or black INK ALL INFORMATION Box 68693 Harrisburg, PA 17106-8693. If you have a valid License, Permit(s) and/or Camera Card in your possession, you MUST surrender the valid product to earn suspension credit. You may not retain your PA Driver's License for photo identification purposes. This form may ONLY be used under the circumstances listed in Section B. ALL information in Section A, B, & C Must be completed with a Signature and Date or credit will not be given. A PA DRIVER'S LICENSE/PERMIT NUMBER LAST NAME JR.,ETC. FIRST NAME MIDDLE NAME.
PLEASE PRINT. X. SIGNATURE IN INK. ACKNOWLEDGMENT. I, _____ hereby acknowledge that my driving privilege is Suspended/Revoked/Disqualified in Pennsylvania.
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