PennDOT - Non-Commercial Learner's Permit Application

LICENSE REQUIRED FEE4-Year Photo$ Photo (Age 65 & Over)$ 'S LICENSE NUMBER: ALL QUESTIONS MUST BE ANSWERED (Check [4] Applicable Block) YES NOTHIS form IS VALID FOR 1 YEAR FROM THE DATE OF PHYSICAL EXAMINATIONThe physical date may not be more than 6 months prior to your 16th AND CERTIFICATION1. Have you ever held or possessed a Driver's License (DL)/ Learner's Permit (LP)/Photo Identification Card (ID) from PA or any other state?..If yes, State: _____ DL/LP/ID #: _____ Name if different than above: _____ State: _____ DL/LP/ID #: _____ Name if different than above: _____ State: _____ DL/LP/ID #: _____ Name if different than above: _____2.

THIS FORM IS VALID FOR 1 YEAR FROM THE DATE OF PHYSICAL EXAMINATION. ... NON-COMMERCIAL LEARNER'S PERMIT APPLICATION. ... (cellphone, cable, electric, gas) •Post-marked mail/package labels through USPS, UPS, FedEx etc. •A W-2 form/pay stub • Lease agreements or mortgage documents ...

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