Virginia Drivers License Number Dd

Posted : admin On 26.01.2020

Driver's License and Identification Card Application - Virginia

NOTE: YOUR ADDRESS BELOW MUST BE CURRENT. THE U.S. POSTAL SERVICE WILL NOT FORWARD.

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CUSTOMER NUMBER
Document TypeDocument NumberExpiration Date (mm/dd/yyyy)

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Document TypeDocument NumberExpiration Date (mm/dd/yyyy)
Document TypeDocument NumberExpiration Date (mm/dd/yyyy)
DOCUMENT VERIFIER SIGNATURE AND LOGONIDCSR SIGNATURE AND LOGONID
PROOF OF SOCIAL SECURITY (specify)
PROOF OF RESIDENCY
FEMALEMALE
FT. IN.
LBS.
COUNTY OFCITY
SOCIAL SECURITY NUMBER BIRTHDATE (mm/dd/yyyy)FULL LEGAL NAME (last, first, middle, suffix)
IF YOUR NAME HAS CHANGED, PRINT YOUR FORMER NAME HERE
MAILING ADDRESS (if different from above - this address will show on your license/ID card) APT NO. CITY STATE ZIP CODE
Purpose: Use this form to apply for a Virginia Driver's License or Identification Card.
Instructions: Complete the front and back of this application. Note: A $5 service fee applies to each license or ID card renewal conducted in a CSC if the
transaction is eligible to be performed by internet, automated telephone or mail, unless the renewal is conducted with another transaction that
Note: Va. Code §§46.2-323 and 46.2-342 require that you provide DMV with the information on this form (including your social security number). It is not necessary to provide a social security
number for an identification card. This social security number is for record keeping purposes and may be disseminated only in accordance with Va. Code §§46.2-208 and 46.2-209. Persons
convicted of certain sexual offenses (as listed in Va. Code §9.1-902) must register or re-register with the Virginia Department of State Police as provided in Va. Code §§9.1-901, 9.1-903, and
9.1-904. If you provide a non-Virginia residence/home address or non-Virginia mailing address, your application for a driver's license or identification (ID) card may be denied.
APPLICANT INFORMATION
DRIVER'S LICENSE AND IDENTIFICATION CARD APPLICATION
DL 1P (07/01/2015)
Are you a citizen of the United States of America?Do you want to apply to register to vote or change your voter registration
YES
NO
INFORMATION FOR THE DEPARTMENT OF ELECTIONS
Completion of this section is requested but not required to apply for a driver's license or ID Card. (Virginia Code §2.2-3806)
Yes, I would like to remain or become an organ, eye and tissue donor.
(INITIAL BOX)
(INITIAL BOX)
1.Driver's License
Learner's Permit and Driver's License
Motorcycle Learner's Permit (classification not applicable)
Driver's License with School Bus Endorsement
5.
6.
7.
8.
9.
Motorcycle Only License*New/Upgrade/Transfer Motorcycle Class*
10.Motorcycle
*Check one if New/Upgrade/Transfer or Motorcycle Only ---►
M ( both 2 wheels and 3 wheels) M 3 ( 3 wheels) M 2 ( 2 wheels)
I certify I cannot surrender my current license or ID card because it is:
Destroyed or MutilatedStolen
11.Replacement license or identification card (check one of the following):
Do you currently have or have you ever held a driver's license, commercial driver's license or learner's permit from Virginia, another state, U.S. territory or
Yes -- provide the following:No
LICENSE NUMBERISSUE DATE (mm/dd/yyyy)EXPIRATION DATE (mm/dd/yyyy)STATE/COUNTRY
1. Do you wear glasses or contact lenses?
2. Do you have a physical or mental condition which requires that you take medication?
3. Have you ever had a seizure, blackout, or loss of consciousness?
4. Do you have a physical condition which requires you to use special equipment in order to drive?
5. Have you been convicted within the past ten years in this state or elsewhere of any offense
resulting from your operation of, or involving, a motor vehicle? (Do not include parking tickets.)
6. Has your license or privilege to drive ever been suspended, revoked, or disqualified in this state
or elsewhere, or is it currently suspended, revoked or disqualified?
SPECIAL INDICATOR REQUEST
Please show the following indicator(s) on my license
Insulin-dependent diabetic
Intellectual disability (IntD)
Speech impairment
If you answered YES to any of the above provide an explanation here.
PASS FAIL
DL ROAD SIGNS EXAM
DL SKILLS
MOTORCYCLE SKILLS M2
RENEWALDUPLICATEREISSUEORIGINAL
APPLICANT UNDER AGE 18 Have you ever been found not innocent of any offense in a Juvenile and Domestic Relations Court in this or any other state?
If you answered YES, a court within your jurisdiction must provide court consent below.
COURT CONSENT In my opinion the applicant's request for a learner's permit/driver's license
REMARKS:
PARENT/GUARDIAN NAME (print)PARENT/GUARDIAN SIGNATUREDATE (mm/dd/yyyy)
DATE (mm/dd/yyyy)JUDGE SIGNATURE JUDGE NAME (print)
I certify that I am employed by the:
to operate a motorcycle or commercial motor vehicle and, because of such employment, I am entitled to the waiver of the motorcycle class and/or
commercial motor vehicle endorsement fee, provided I have paid for and hold a valid Virginia driver's license or have made application for such.
County ofCommonwealth of Virginia orCity ofTown of
All males under the age of 26 are required to check one of the following. Failure to provide a response will result in denial of your application.
By signing this application, I consent to be registered with Selective Service, if required by federal law. If under age 18, an appropriate adult must complete
and sign below: I authorize DMV to send information to Selective Service which will be used to register applicant when he is 18 years old.
I am a non-immigrant alien in the U.S. and not required to register.
I authorize DMV to forward to the Selective Service System personal information necessary to register me with Selective Service.
EMANCIPATED MINORPARENT/GUARDIAN JUDGE, JUVENILE DOMESTIC RELATIONS COURT
I certify and affirm that I am a resident of Virginia, that all information presented in this application is true and correct, that any documents I have presented
to DMV are genuine, and that my appearance, for purpose of my DMV photograph, is a true and accurate representation of how I generally appear in public.
I make this certification and affirmation under penalty of perjury and understand that knowingly making a false statement on this application is a criminal
DATE (mm/dd/yyyy)APPLICANT SIGNATURE APPLICANT NAME (print)
been previously licensed within the past
using the Supplemental Driver's
Remove Endorsement(s)I want to remove the following endorsement(s) from my
XTNHSP
I want to apply for the following vehicle

Colorado Driver License Number On Card

H - Hazardous Materials
X - Tank and Hazardous Materials
P - Passenger Carrying Vehicle
(16 or more passengers)
STATELICENSE NUMBER
LICENSE EXPIRATION DATE (mm/dd/yyyy)
I want to be licensed to operate the type of vehicle(s) checked below:
A - Combination vehicle with GVWR or GCWR of 26,001 lbs. or more
B - Single vehicle with GVWR of 26,001 lbs. or more, or towing a
C - Any vehicle that does not fit the definition of a Class A or Class B
vehicle and is either used to transport hazardous materials or
designed to carry 16 or more passengers, including the driver.
AIR BRAKES With (Full Air or Air Over Hydraulic) Without
box for the
category that
INTERSTATE DRIVERINTRASTATE DRIVER
Requires an Intrastate Only restriction on the CDL (K)
NON-EXCEPTED - I meet the qualification requirements
under 49 CFR Part 391 of the Federal Motor Carrier Safety
Regulations. (Medical examiner's certificate required)
NON-EXCEPTED - I meet the qualification requirements
under Title 19 § 30-20-80 of the VA Administrative Code.
EXCEPTED - I am exempt from the qualification
requirements under 49 CFR Part 391 of the Federal Motor
Carrier Safety Regulations. (No medical examiner's
EXCEPTED - I am exempt from the qualification
Administrative Code. (No medical examiner's certificate required)
COMMERCIAL DRIVER'S LICENSE/LEARNER'S PERMIT APPLICANTS
PLACE OF DOMICILE - Your place of domicile may or may not be the same as your place of residence. Your place of residence is where you currently live
and your place of domicile is where your true, fixed and permanent home and principal residence is and to which you intend to return whenever you are
Virginia
Another U.S. state/territory or Canada/Mexico (not eligible - must apply
Outside of Virginia/Active Duty U.S. Military
A country other than the U.S. (unexpired EAD or foreign passport and
PARENT OR LEGAL GUARDIAN LICENSE CONSENT
Check applicable box, review certification statement, print your name and sign where indicated.
I authorize issuance of a learner's permit/driver's license. I certify that the applicant is a resident of Virginia. I certify that the applicant is
attending school regularly and is in good academic standing, but if not, I authorize issuance of a learner's permit/driver's license. I certify that this
applicant will operate a motor vehicle for at least 45 hours (15 of which will occur after sunset) while holding a learner's permit.
If the applicant attends public school, I authorize the principal or designee of the public school attended by the applicant to notify the juvenile and
domestic relations district court (within whose jurisdiction the applicant resides) when the applicant has had 10 or more unexcused absences from
If a Special Indicator Request is checked on this application, I request on behalf of the applicant that it be shown on the learner's permit/driver's license.
I certify that the statements made and the information submitted by me are true and correct.

Virginia Drivers License Number Dd

I authorize issuance of an ID card. If the applicant is under age 18, I certify that the applicant is a resident of Virginia. If a Special Indicator

Va Drivers License Customer Identifier

Request is checked on this application, I request on behalf of the applicant that it be shown on the identification card.

Virginia Driver's License Dd

I certify that the statements made and the information submitted by me are true and correct.