Transcription of PennDOT - Application for Initial Identification
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Example: dental hygienist
PennDOT - Application for Initial Identification
SIGNATURE OF EXAMINER DATEBADGE CENTER LAST NAME FIRST NAME MIDDLE NAMEDATE OF BIRTHSEX SOCIAL SECURITY NUMBER OR DRIVER'S LICENSE NUMBERMONTH I HAVE NEVER HELD A PA DRIVER'S LICENSE/PERMIT OR Identification CARD AND I AM APPLYING FOR AN Initial Identification CARD. (You must apply in person at any Driver License Center.) CURRENTLY HOLD A PA DRIVER'S LICENSE/PERMIT AND AM APPLYING FOR A NON-DRIVER Identification CARD FOR THE FOLLOWING REASON:I am surrendering my driving privilege for health reasons that may affect my ability to safely operate a motor vehicle. I understand that my license will not be reissued until I successfully complete the appropriate examination. (If you have not already surrendered your Driver's License/ Learner's Permit, please attach it to this Application .)
here. 3. imprisonment up to 1 year (18 pa. c, section 4904 [b]). signature of parent, guardian, persons in loco parentis, or spouse at least 18 years of age date. applicant's signature in ink date sign. x. here. sign. x. here
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