Transcription of CONTINUED ON BACK - Rhode Island
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CONTINUED ON BACK - Rhode Island
TRANSACTION TYPE (SELECT ONE)LICENSE(complete sections A, B, C, D, E*, F*G)A. APPLICANT S INFORMATION (COMPLETE ALL FIELDS)TELEPHONE:SUFFIX:RI DRIVER S LICENSE # / ID # / PERMIT #:DATE OF BIRTH: (MM/DD/YY)GENDER:SOCIAL SECURITY NUMBER:HEIGHT: : COLOR:COUNTRY:STATE/PROVINCE:CITY:CONTIN UED ON BACKC. PHYSICAL INFORMATION (COMPLETE ALL FIELDS)D. GENERAL QUESTIONS (COMPLETE ALL FIELDS)NEWPASSPORT / EMPLOYMENT AUTHORIZATION / RESIDENT ALIEN CARD #:MALEFEMALEDo you want to register as an organ and tissue donor?ACTIVE MILITARY:100% DISABLED VETERAN:YESNOB.
Rhode Island DMV – Document Checklist LICENSE & ID CARDS www.dmv.ri.gov rev. 12/14 New Permit LI-1 form A certified birth certificate (not a
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