Transcription of Restricted Driver License Application
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Restricted Driver License Application
RESL RESA XFor validation only 106-040-254-0005 Restricted License fee _____Date received _____LSR initials _____Office no. _____ Restricted Driver License ApplicationUse this form to apply for a temporary Restricted Driver License if your driving privilege in Washington is currently suspended or revoked. To apply, take this completed Application and a $100 nonrefundable Application fee to any Driver licensing office or mail your Application with a check or money order payable to the Department of Licensing to: Restricted LicensingDepartment of LicensingPO Box 3907 Seattle, WA 98124-3907 PRINT or TYPE Name (Last, First, Middle initial) Driver License number State/JurisdictionDate of birth (Area code) Daytime phone number Gender Height Weight Eye colorAddress (Street address or PO Box, City, State, ZIP code)Eligibility/Restrictions We will determine what type of temporary Restricted License you qualify for based on our evaluation of your driving record.
Restricted Driver License Application Use this form to apply for a temporary restricted driver license if your driving . privilege in Washington is currently suspended or revoked. To apply, take this ... To apply, submit a Financial Assistance Application (DR-500-024) located at dol.wa.gov.
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