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DL-5 (8-19)

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?

Take your completed and signed application, along with your $10.00 check or money order payable to “PennDOT” to the nearest Driver Licensing site. Upon passing the motorcycle knowledge test, your application and fee will be processed and you will be issued a permit.

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Transcription of DL-5 (8-19)

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