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HARDSHIP PERMIT APPLICATION - Oregon

MON TUE WED THU FRI SAT SUNMON TUE WED THU FRI SAT SUNHARDSHIP PERMIT APPLICATION Mail APPLICATION and all requirements to: DMV, 1905 LANA AVE NE, SALEM OR 97314 - NOT ISSUED FOR COMMERCIAL (CDL) DRIVING PRIVILEGES - SECTION 1 DRIVER INFORMATION DRIVER LICENSE / CUSTOMER NUMBERDATE OF BIRTH FULL LEGAL NAME (Print: last, first, middle) CONTACT PHONE NUMBER ( ) RESIDENCE ADDRESS (Address will be used to update your driver record/license) (MUST be an Oregon resident) MAILING ADDRESS IF DIFFERENT (Address will be used to update your driver record/license) SECTION 2 DRIVING FOR WORK NAME OF EMPLOYER, COMPANY, ETC.

Have an automobile insurance company file an Oregon SR-22 certificate with DMV. Must be the original SR-22 (no copies or faxes). DMV will not issue the permit until the SR-22

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  Applications, Permit, Oregon, Hardship, Hardship permit application

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