REAL ID INDICATOR REQUEST FORM

1 real ID INDICATOR REQUEST FORMDL-63 RID (3-19)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 notmake application at a real ID Driver License Center your product will be mailed to certify under penalty of law that all information given on this application is true and correct. If using a Messenger Service, I hereby authorizethe Department to furnish them with my driving record for the purpose of processing this form. I hereby acknowledge this day that I havereceived notice of the provisions of Section 3709 of the Vehicle Code.

2 (See reverse for provisions.) (Applicant s Signature in Ink) (Date)XSIGNHEREE-MAIL ADDRESS (if applicable)DRIVER INFORMATIONFIRST NAMEDRIVER S LICENSE NUMBERLAST NAME(S)DATE OF BIRTHMIDDLE NAMEJR/ETCMONTH DAY YEARADDREAL ID INDICATOR - There will be a one-time non-refundable$30 real ID fee.

3 The non-refundable$30 fee will be addedto 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 card holders are required to submit a renewal application (DL-54B form), along with the applicable renewal 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 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.

4 If the license is within 6-months of expiration, a renewal application(DL-143CD form) is required, along with the applicable CDL renewal license holders may either apply to renew the CDL (DL-143CD) or apply for a duplicate CDL (DL-80CD), along withthe applicable renewal/duplicate ID INDICATORI understand that if I should choose to opt back into the real ID program later, I will be required to submit my identity andresidency documentation in person at a PennDOT Driver License Center. Additionally, I understand that I will be required to paythe applicable non-refundableREAL ID opt-in fee.

5 TRANSFERREAL ID INDICATORI would like to transfer my real IDINDICATOR from my driver s license to my identification card. (NOTE: A DL-54B form, alongwith the applicable fee, must accompany this REQUEST to transfer.)I would like to transfer my real IDINDICATOR from my identification card to my driver s license. (NOTE: A DL-80, or DL-80 CDfor CDL holders, along with the applicable fee must accompany this REQUEST to transfer.) AUTHORIZATION AND CERTIFICATIONWARNING: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)).

6 PROOF OF IDENTITYYou will need to provide ONEdocument proving your identity and your lawful status in the United States when applying for a real ID. Themost 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 otherbirth 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)If you are a lawful permanent resident, acceptable documents include.

7 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 NUMBERYou must present your social security cardwhen applying for a real ID. Your card must be original. Social Security Card in current namePROOF OF YOUR PENNSYLVANIA RESIDENCYE veryone, regardless of age, will need to provide TWOdocuments to prove Pennsylvania residency when applying for a real ID. Selectwhich 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.

8 A W-2 form/pay stub Lease agreements or mortgage documents Tax recordsFor additional information on real ID, please visit the Department of Homeland Security's website at OF YOUR PENNSYLVANIA RESIDENCYS ection 3709 provides for a fine of up to $300 for dropping, throwing or depositing, upon any highway, or upon any other public or privateproperty 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 thepreceding without immediately removing such items or causing their any violation of Section 3709, I may be subject to a fine of up to $300 upon conviction, including any violation resulting from theconduct of any other persons present within any vehicle of which I am the CHANGE - If you desire to use your birth name, you must present your state issued birth certificate with a raised seal.

9 If yourname changed by permission of court, you must present a Certified Copy of the Court Order. If you desire to use your spouse ssurname, you must present your certified marriage certificate. If you desire to use another name, you must present a court ordershowing your full legal report errors on your driver s license relating to name, date of birth or social security number, please contact PennDOT sCustomer Care Center at you are required to present supporting documentation to correct your record, all documents must be originals andpresented in person at a PennDOT Driver License Center.

10 For NAME corrections, you must present your state issued birth certificate with a raised seal, a Certified Copy of theCourt 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 complete the appropriate driver license application for change/correction and submit with this form.