Transcription of Driver's License and Identification Card Application
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Driver's License and Identification Card Application
NOTE: YOUR ADDRESS BELOW MUST BE CURRENT. THE POSTAL SERVICE WILL NOT FORWARD YOUR License OR ID NUMBER (optional)GENDER (check one) FEMALEMALEWEIGHT OF CITY OR COUNTY OF RESIDENCE COUNTY OFCITYSOCIAL SECURITY NUMBER (SSN)BIRTHDATE (mm/dd/yyyy)FULL LEGAL NAME (last, first, middle, suffix)EYE COLORHAIR COLORIF YOUR NAME HAS CHANGED, PRINT YOUR FORMER NAME HERE APPLICANT INFORMATIONSTREET ADDRESS APT NO. CITY STATE ZIP CODEHEIGHT FT. ADDRESS (if different from above - this address will show on your License /permit/ID) APT NO. CITY STATE ZIP CODESPECIAL INDICATOR REQUESTP lease show the following indicator(s) on my License , permit, or ID card:Must submit required physician statement Insulin-dependent diabeticSpeech impairment Hearing impairment ( License only)Intellectual disability (IntD)Autism spectrum disorder (ASD)1.
Upon issuance of a driver’s license, commercial driver's license or identification card in the Commonwealth of Virginia, any driver’s license, commercial driver's license or identification card previously issued by another state must be surrendered and will …
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