Transcription of (SEE INSTRUCTIONS ON BACK) - Connecticut
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(SEE INSTRUCTIONS ON BACK) - Connecticut
REQUEST FOR A Connecticut DRIVER'S DMV VALIDATION AREA. LICENSE/IDENTIFICATION CARD BY MAIL. B-350 Rev. 12-17 STATE OF Connecticut . DEPARTMENT OF MOTOR VEHICLES. CENTRAL ISSUANCE OPERATIONS UNIT. 60 STATE STREET, WETHERSFIELD, CT 06109. (SEE INSTRUCTIONS ON BACK). NAME OF APPLICANT ON DRIVER'S LICENSE (Last, First, Middle Initial) DRIVER'S LICENSE OR ID CARD NUMBER (If known) DATE OF BIRTH. STREET ADDRESS WHERE LICENSE IS TO BE MAILED EYE COLOR GENDER HEIGHT. CITY STATE COUNTRY ZIP/POSTAL CODE CLASS (If known) ENDORSEMENTS (If known) RESTRICTIONS (If known). SECTION A. STATE THE REASON YOU CANNOT APPEAR AT DMV IN PERSON. OUT-OF-STATE OUT-OF-COUNTRY INCARCERATED/INMATE NUMBER: MILITARY. (Complete Section E on back of form). OTHER (Explain): APPLICATION FOR: REASON FOR DUPLICATE: DUPLICATE LICENSE ($ ) RENEWAL OF NON-DRIVER ID ($ ) LOST. DUPLICATE NON-DRIVER IDENTIFICATION CARD ($ ) RENEWAL OF DRIVER LICENSE ($ for 6 year renewal or $ for 2.)
Circle applicable fees and determine correct amount Renewal of a 2 year driver license (only available for operators 65
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