Transcription of NAME (Last, First, Middle) OPERATOR LICENSE/ID NUMBER ...
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NAME (Last, First, Middle) OPERATOR LICENSE/ID NUMBER ...
B-58 IND Rev. 12-2017 STATE OF connecticut FOR DMV INTERNAL USE ONLY. DEPARTMENT OF MOTOR VEHICLES LICENSE/ID . INDIVIDUAL CHANGE OF ADDRESS/VOTER REGISTRATION APPLICATION CHANGES COMPLETED. INSTRUCTIONS: (Please print in ink or type): You are only required to fill in the sections applicable to your needs. REGISTRATION. CHANGES COMPLETED. Please mail completed form to: DMV Change of Address Unit, 60 State Street, Wethersfield, CT 06161-1015. NAME (Last, First, Middle) OPERATOR LICENSE/ID NUMBER BIRTH DATE. SIGNATURE DATE SIGNED TELEPHONE NUMBER . X. ** FORMS WITHOUT A NAME, OPERATOR LICENSE/ID , BIRTH DATE, AND SIGNATURE WILL NOT BE PROCESSED **.
state of connecticut department of motor vehicles individual change of address/voter registration application b-58 ind rev. 12-2017 for dmv internal use only license/id changes completed
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