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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. If this exception applies to you, please check the appropriate box and include documentation of your status with this certify that my workplace is located out of state and I am employed by, or am the immediate family of a person employed by: US Armed Forces Federal Government PA State Employment Relationship to person meeting exemption (check one): Spouse Dependent Child Marriage Divorce Other (see instructions) _____ VEHICLE INS

An Ignition Interlock Limited License (IILL) is a driver’s license issued to a driver whose Pennsylvania driving privilege has been suspended or revoked for one or more violations of driving under the influence of alcohol or a controlled substance or …

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