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DRIVER’S LICENSE/IDENTIFICATION CARD …

101 Hospital Street 29 State House Station Augusta, Maine 04333 207-624-9000 ext. 52114; TTY Users call Maine relay 711 MVL 17 Rev 09/2015 DRIVER S LICENSE/IDENTIFICATION CARD residency ELIGIBILITY AFFIDAVIT I _____, of _____, (Printed Name of Person Certifying residency ) (Street Address of Person Certifying residency ) in _____, _____ _____, certify that _____ (City/Town) (State) (Zip Code) (Printed Name of Applicant) of _____ in _____ physically resides in the State of Maine.

101 Hospital Street 29 State House Station Augusta, Maine 04333 207-624-9000 ext. 52114; TTY Users call Maine relay 711 MVL 17 Rev 09/2015 DRIVER’S LICENSE/IDENTIFICATION CARD RESIDENCY ELIGIBILITY AFFIDAVIT INSTRUCTIONS

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