REAL ID INDICATOR REQUEST FORM

1 DL-63 RID (3-19). REAL ID INDICATOR REQUEST FORM. You must make application in person at a REAL ID Driver License Center in order to receive your product the same day. If you do not make application at a REAL ID Driver License Center your product will be mailed to you. DRIVER INFORMATION. DRIVER'S LICENSE NUMBER LAST NAME(S) JR/ETC. FIRST NAME MIDDLE NAME. DATE OF BIRTH E-MAIL ADDRESS (if applicable). MONTH DAY YEAR. ADD REAL ID INDICATOR - There will be a one-time non-refundable $30 REAL ID fee. The non-refundable $30 fee will be added to the required driver license or identification card fee: Non-commercial license holders are required to submit a renewal application (DL-143 form), along with the applicable renewal fee. Identification card holders are required to submit a renewal application (DL-54B form), along with the applicable renewal fee.

2 Citizens with a non-commercial license that is not yet eligible for renewal are required to apply for a duplicate license (DL-80 form), along with the applicable duplicate fee. If the license is within 6-months of expiration, a renewal application (DL-143 form) is required, along with the applicable renewal fee. Citizens with a commercial license that is not yet eligible for renewal are required to apply for a duplicate license (DL-80CD form), along with the applicable duplicate fee. If the license is within 6-months of expiration, a renewal application (DL-143CD form) is required, along with the applicable CDL renewal fees. Commercial license holders may either apply to renew the CDL (DL-143CD) or apply for a duplicate CDL (DL-80CD), along with the applicable renewal/duplicate fee. REMOVE REAL ID INDICATOR . I understand that if I should choose to opt back into the REAL ID program later, I will be required to submit my identity and residency documentation in person at a PennDOT Driver License Center.

3 Additionally, I understand that I will be required to pay the applicable non-refundable REAL ID opt-in fee. TRANSFER REAL ID INDICATOR . I would like to transfer my REAL ID INDICATOR from my driver's license to my identification card. (NOTE: A DL-54B form, along with the applicable fee, must accompany this REQUEST to transfer.). I would like to transfer my REAL ID INDICATOR from my identification card to my driver's license. (NOTE: A DL-80, or DL-80CD. for CDL holders, along with the applicable fee must accompany this REQUEST to transfer.). AUTHORIZATION AND CERTIFICATION. I certify under penalty of law that all information given on this application is true and correct. If using a Messenger Service, I hereby authorize X. the Department to furnish them with my driving record for the purpose of processing this form. I hereby acknowledge this day that I have received notice of the provisions of Section 3709 of the Vehicle Code.

4 (See reverse for provisions.). SIGN. HERE. (Applicant's Signature in Ink) (Date). WARNING: Misstatement of fact is a misdemeanor of the third degree punishable of up to $2,500 and/or imprisonment up to 1 year (18 Pa Section 4904(b)). PROOF OF IDENTITY. You will need to provide ONE document proving your identity and your lawful status in the United States when applying for a REAL ID. The most common documents you can use to prove your identity are: If you are a citizen, acceptable documents include: Birth Certificate with raised seal ( issued by an authorized government agency, including territories or Puerto Rico.) No other birth documents will be accepted A valid Passport or Passport Card Certificate of Citizenship (USCIS Form N-560) or Consular Report of Birth Abroad (DOS Form FS-240). Certificate of Naturalization (USCIS Form N-550 or N-570).

5 If you are a lawful permanent resident, acceptable documents include: I-551 Permanent Resident Card (Green Card). Passport with I-551 stamp Machine-readable Immigrant Visa Re-entry Permit I-327. PROOF OF SOCIAL SECURITY NUMBER. You must present your social security card when applying for a REAL ID. Your card must be original. Social Security Card in current name PROOF OF YOUR PENNSYLVANIA RESIDENCY. Everyone, regardless of age, will need to provide TWO documents to prove Pennsylvania residency when applying for a REAL ID. Select which residency documents you will bring to the Driver License Center. Current, unexpired PA driver's license or photo ID card Current PA vehicle registration card Current auto insurance card A computer-generated utility bill showing your name and address (cell phone, cable, electric, gas). Post-marked mail/package labels through USPS, UPS, FedEx etc.

6 A W-2 form/pay stub Lease agreements or mortgage documents Tax records For additional information on REAL ID, please visit the Department of Homeland Security's website at CHANGE/CORRECTION Please complete the appropriate driver license application for change/correction and submit with this form. ONLY. NAME CHANGE - If you desire to use your birth name, you must present your state issued birth certificate with a raised seal. If your name changed by permission of court, you must present a Certified Copy of the Court Order. If you desire to use your spouse's surname, you must present your certified marriage certificate. If you desire to use another name, you must present a court order showing your full legal name. To report errors on your driver's license relating to name, date of birth or social security number, please contact PennDOT's Customer Care Center at 717-412-5300.

7 If you are required to present supporting documentation to correct your record, all documents must be originals and presented in person at a PennDOT Driver License Center. For NAME corrections, you must present your state issued birth certificate with a raised seal, a Certified Copy of the Court Order or your certified marriage certificate. For DATE OF BIRTH corrections, you must present state issued birth certificate with raised seal. For SOCIAL SECURITY NUMBER corrections, you must present your Social Security Card. *Note: All name changes must be made in person at a Driver License Center. All documents must be original. PROOF OF YOUR PENNSYLVANIA RESIDENCY. Section 3709 provides for a fine of up to $300 for dropping, throwing or depositing, upon any highway, or upon any other public or private property without the consent of the owner thereof or into or on the waters of this Commonwealth, from a vehicle, any waste paper, sweepings, ashes, household waste, glass, metal, refuse or rubbish or any dangerous or detrimental substance, or permitting any of the preceding without immediately removing such items or causing their removal.

8 For any violation of Section 3709, I may be subject to a fine of up to $300 upon conviction, including any violation resulting from the conduct of any other persons present within any vehicle of which I am the driver.