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PennDOT Home
LICENSE NUMBERDRIVER INFORMATION (Type or print information) MIDDLE NAMEDATE OF BIRTH (must be listed)MONTH DAY YEARFIRST NAMEJR., NAMETELEPHONE NUMBER (BETWEEN 8:00 AM - 4:30 PM)MONTH DAY YEARLICENSE EXPIRATION DATEABIGNITION INTERLOCK LIMITED LICENSE (IILL) PETITIONB ureau of Driver Licensing Box 68273 Harrisburg, PA 17106-8273DL-9108 (1-18)THIS AREA IS FOR CHANGES OR CORRECTIONS ONLY - (Only fill in the information you want to change or correct)ADDRESS CHANGE YES NONAME CHANGE OUT-OF-STATE ADDRESS CHANGE. We may not issue driver license products to an out-of-state address, except in the case of an employee of federal or state government, armed forces personnel, or their families, whose workplace is located outside of Pennsylvania.
DL-9108 (12-21) X DATE SEND BY CERTIFIED MAIL TO: PA Department of Transportation Bureau of Driver Licensing Restorations Unit P.O. Box 68273 Harrisburg, PA 17106-8273 CHECKLIST BY LAW, YOU MUST SURRENDER YOUR DRIVER’S LICENSE OR SUBMIT AN ACKNOWLEDGEMENT FORM AS PART OF THE PETITION PROCESS (75 Pa C.S., Section …
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