Transcription of DL-5 (5-18) - dot.state.pa.us
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DL-5 (5-18) - dot.state.pa.us
AYOU MUST COMPLETE ALL PARTS OF SECTION ATELEPHONE NUMBER (8 - 4 )MONTHDAYYEARLAST NAMEDRIVER S LICENSE NUMBERDATE OF NAMEMIDDLE NAMEE-MAIL ADDRESS (if applicable)Check applicable block: Add/Reapply Duplicate Change CorrectZIP CODES TAT ENAME CHANGE (Please note all name changes must be done in person with original documents) REASON: MARRIAGE DIVORCE OTHER (see reverse side) LASTNEWSTREETADDRESSCITY CHANGE OR CORRECTION ONLY (Important information on reverse side)JR., NAMEFIRST NAMEMONTHYEARCORRECTION OF DATE OF BIRTHIf you are a registered voter in PA, would you like us to notify your county voter registration office of this change? YES NOIf you are not a registered voter, you may contact your county voter registration COLOR (Please check one): BLUE BROWN GREEN HAZEL PINK BLACK GRAY DICHROMATIC OTHER _____ OTHER CHANGESADDRESS - A Post Office Box number may be used in addition to the actual residence address, but cannot be used as the only address.
The most current version of this form can be found at: www.dmv.pa.gov OUT-OF-STATE ADDRESS CHANGE. We may not issue driver license products to an out-of-state address, except in the case
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