Transcription of DMV APPLICATION FOR DRIVING PRIVILEGES OR …
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DMV APPLICATION FOR DRIVING PRIVILEGES OR …
LAST NAME (PRINT NAME) CLASS CINSTRUCTION PERMITDRIVER LICENSEENDORSEMENTID F XDo you want your license or ID card to showthat you are an anatomical donor? S PLACE OF BIRTH (CITY & STATE OR COUNTRY)MOTHER'S MAIDEN NAMEFIRST NAMEDRIVER / ID NUMBER RESTRICTIONSHEIGHTWEIGHTSEX(CIRCLE)EYE COLORHAIR COLORRESIDENCE ADDRESSCITY, STATE, ZIP CODEMAILING ADDRESS (IF DIFFERENT FROM RESIDENCE ADDRESS)CITY, STATE, ZIP CODENOYESAPPLICATION FOR DRIVING PRIVILEGES OR ID CARD 735-173 (1-18)DATE STAMPSTK# 300093 TSR IDYou are required to report any mental or physical condition or impairment that affects your ability to drive safely. You are not required to report all your health conditions only those that affect your ability to drive safely. DMV will use your answers to the following questions only for the purpose of determining your eligibility for an Oregon DRIVING privilege.
LAST NAME (PRINT NAME) CLASS C DRIVER LICENSE INSTRUCTION PERMIT ENDORSEMENT ID CARD AT-RISK FT. IN. M F X Do you want your license or ID card to show that you are an anatomical donor?
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