Dmv 002 - Driver'S License Or Identification Card Application
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2
3APPLICATION FOR DRIVING PRIVILEGES OR ID CARD
ORIGINAL
RENEWAL DUPLICATE
INSTRUCTION PERMIT
Information in boxes MUST be completed prior to visiting a DMV representative. Please PRINT in black or blue ink only.
LICENSE OR PERMIT
CLASSIFICATION
ENDORSEMENTS
IDENTIFICATION CARD
Real ID
Standard
Class C
Class A
J
G
Real ID
Standard
Driver Authorization Card
Class M
Class B
F
Seasonal Resident
NAME
ADDRESS
DATE OF BIRTH
SOCIAL SECURITY NUMBER
SEX
CHANGE TO INFORMATION ON CARD:
LAST NAME (PRINT)
FIRST NAME
MIDDLE NAME
SUFFIX
NEVADA DL/DAC/ID NUMBER
SOCIAL SECURITY NUMBER (not required for DAC)
DATE OF BIRTH
FULL LEGAL NAME ON BIRTH CERTIFICATE
BIRTHPLACE (CITY & STATE OR COUNTRY)
DO NOT SCAN MY BIRTH CERTIFICATE
SEX (CIRCLE)
HEIGHT
WEIGHT
HAIR COLOR
EYE COLOR
MOTHER’S MAIDEN NAME
M
F
FT.
IN.
LBS.
PRIMARY PHYSICAL ADDRESS
MAILING ADDRESS (IF DIFFERENT FROM PHYSICAL ADDRESS)
CITY, STATE, ZIP CODE
CITY, STATE, ZIP CODE
DAYTIME PHONE NUMBER (OPTIONAL)
EMAIL ADDRESS (OPTIONAL)
(
)
Pursuant to federal law, you may register to vote through the DMV. If you have not previously registered to vote in Nevada or if you
would like to make an update to a current Nevada voter registration, you may do so by completing the additional information on page 3
of this application, including the signature box.
VOTER
Subject to the explanation provided below regarding a move to a different county, any change to address information will be sent to the
REGISTRATION
County Clerk/Registrar’s Office for voter registration purposes unless you check this box: I do not want my address change updated
OR ADDRESS
for voter registration purposes.
CHANGE
Did you move to a different county? Yes No If “yes,” all sections on page 3 of this application must be completed for the new
county to process your updated voter registration.
I declare myself an honorably discharged U.S. Armed Forces veteran and authorize the DMV to send
YES
NO
my personal information to the Department of Veterans Services to provide benefits information to me.
VETERAN
I have a U.S. Armed Forces honorable discharge and wish to have a veteran designation placed/retained
YES
NO
on my license. If your card does not already have a veteran designation, present proof of honorable discharge.
If you are a male at least 18-26 yrs. old and do not check the box below, you will be registering for Selective Service. You will remain
SELECTIVE
eligible for federal student loans, grants, benefits relating to job training, most federal jobs and, if applicable, citizenship in the United
SERVICE
States. I do not want to register for the Selective Service.
Would you like to be an organ donor and have that indicated on your license or identification card?
Yes, I wish to be an organ donor or
No, I do not wish to be an organ donor at this time.
ORGAN
If you are at least 16 and less than 18 years old, a parent or guardian may sign the affidavit to ensure your wishes are followed.
DONOR
Would you like to donate $1 or more to the anatomical gift account? If so, how much?
$_______________
UNDER WHAT NAME WAS IT ISSUED?
Have you ever had a driver’s license or identification card in another name?
YES NO
Have you ever had a driver’s license or identification card in another state?
YES NO
What state(s)? _____________________
Is the card in your possession? YES NO
License No. _____________________
Class/Type _______ Expiration Date ___________________
Has your driving privilege ever been revoked, suspended, canceled or denied?
YES NO
If yes, State _____________ Date ______________ Reason ___________________________________________________________________________
Do you have any disability, illness, missing extremity, or take any medication that could affect your driving ability?
YES NO
If yes, please explain ___________________________________________________________________________________________________________
If you wish, some medical conditions may be indicated on your DL/DAC/ID. Form DLD7 must be completed by your physician.
Vision Acuity:
Left
Both
Right
Office Use Only
Ind. ID # ___________________________________
With OR Without Correction:
20/___
20/___
20/___
Written
Reinstatement Info ___________________________
nd
PDPS/CDLIS: Clear Hit W/D:_____ Cites:_____ 2
Hit
Drive
Restrictions ________________________________
State:_______________
DLN:_________________________
Score(s) _______________________________________________________
Docs / Notes:________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
1
DMV 002 (Revised 01-2017)
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