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STATE PA BLUE

AYOU MUST COMPLETE ALL PARTS OF SECTION ATELEPHONE NUMBER (8 - 4 )MONTHDAYYEARLAST NAMEDRIVER S license NUMBERDATE OF NAMEMIDDLE NAMEE-MAIL ADDRESS (if applicable)ZIP CODES TAT ENAME CHANGE (Please note all name changes must be done in person with original documents) REASON: MARRIAGE DIVORCE OTHER (see reverse side) LASTNEW STREET ADDRESSCITY JR., NAMEFIRST NAMEMONTHYEARCORRECTION OF DATE OF BIRTHIf you are a registered voter in PA, would you like us to notify your county voter registration office of this change? YES NOIf you are not a registered voter, you may contact your county voter registration office.

DL-80 (5-18) The most current version of this form can be found at: www.dmv.pa.gov ... Complete form DL-143 (Renewal of a Non-Commercial Driver’s License).

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  Drivers, Commercial, License, Non commercial driver s license

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