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.
REAL ID: ID requirements for domestic air travel and access to secure federal facilities change May 3, 2023. A REAL ID meets these requirements. ... If a Special Indicator Request is checked on this application, I request on behalf of the applicant that it be shown on the learner's permit/driver's license.
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