Massachusetts Registry Of Motor Vehicles Application Form
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1
2Massachusetts Registry of Motor Vehicles Application for:
Check appropriate box:
Change of Information
Duplicate:
License
Permit
Mass ID
Liquor ID
(Check one)
License Issue
Reinstatement
Renewal:
License
Mass ID
(Check one)
License Class Applying For:
CDL Endorsements Applying For: (For Class A, B, OR C)
A A A A A
B B B B B
C C C C C
D D D D D
M M M M M
AIR BRAKES
COMBO
HAZMAT
PASSENGER
TANK
DOUBLES/TRIPLES
SCHOOL BUS
Fees are payable by Cash, Check, Money Order, Mastercard, Visa, or Discover. If paying by check, please make payable to "Registry of Motor Vehicles" or "RMV".
Identification Requirements
Fees are payable by Cash, Check, Money Order, Mastercard, Visa, or Discover. If paying by check, please make payable to "Registry of Motor Vehicles" or "RMV"
Applicants under 18 years of age are not required to provide proof of residence
For certain transactions, including license conversions, applicants over the
or signature.
age of 18 must present four forms of ID which include:
• SSN Card or valid, current US or non-US passport
If you do not have a SSN, an acceptable written denial notice not more
• Proof of date of birth
than 30 days old, from the Social Security Administration (SSA) is required.
• Proof of signature
You must also provide proof of an acceptable visa status.
• Proof of Massachusetts residency
Please see the Driver’s Manual for the identification requirements you must satisfy to obtain a license or ID and the list of “Acceptable Forms of Identifica-
tion” that may satisfy those requirements. The list is also on our website at www/mass.gov/rmv.
General Applicant Information Please print neatly with a ball point pen in blue or black ink.
Social Security Number (SSN):
MA assigned License/Permit/ID Number:
If you currently use your SSN as your license/permit/ID number, the RMV will automatically issue you a state assigned number.
Federal Law prohibits use of your SSN on a License/Permit/ID.
Name:
Last
First
Middle
Sex:
Date of Birth (month/day/year)
M M M M M
F F F F F
Residential Address: (Where you actually reside)
Street#
Apt/Unit#
City
State
Zip Code
Mail Address: (Where you want us to send your Driver's License/ID and future notices from the RMV)
U.S. Post Office MAY NOT deliver if your name is NOT on the mailbox.
Street#
Apt/Unit#
City
State
Zip Code
Change of Information
(Leave this section blank if no changes)
Check here if your name has changed. Please print your new name in the General Information section and your previous name below.
Previous Name: (Last, First, Middle) ____________________________________________________________________________________
Check here if the address in the General Information section reflects a change of Mailing Address.
Check here if the address in the General Information section reflects a change of Residential Address.
Check here if height has changed. Current height is ft.___ in.___
Check here if sex designation has changed. Note: additional documentation will be required.
Change Sex Designation to:
Male
Female
REQUIRED INFORMATION
to be completed by all applicants
1. Are you currently licensed to drive in any state, the District of Colum-
4. Is your license or RIGHT to operate suspended, revoked,
bia, or a foreign country?
canceled, withdrawn, or disqualified here or in any other state?
Yes
No
Yes
No
If yes, where?___________________________________
If yes, where?
Exp. Date
What Class or type of license? __________________________________
If yes, why?
2. In the past 10 years have you held any class of driver's license in
any other state, the District of Columbia, or a foreign country?
Yes
No
5. Are you an active duty member of the U.S. armed forces?
Yes
No
6. Do you have any medical condition that may affect your ability to safely
If yes, where?
License Class
License #
operate a motor vehicle?
Yes
No
__________________________
______
____________________
(The Medical Advisory Board has established standards to determine fit-
__________________________
______
____________________
ness to operate a motor vehicle. Ask a clerk for a summary of these stan-
__________________________
______
____________________
dards or visit our website at for the complete list of
these standards.)
(inform RMV of previous names) (use additional paper if you need more space)
Yes
3. Do you want to be an organ or tissue donor?
7. Are you currently taking any medication that may affect your ability to
If yes, the RMV will print the designation on your driver's license/ID.
safely operate a motor vehicle?
Yes
No
The RMV is required by law to provide certain information identifying organ donors to federally-
Note: If you answered yes to questions 4, 6, or 7, additional documentation
designated organ procurement organizations and other federally registered non profit eye and tis-
may be required.
sue banks serving the Commonwealth.
(RMV USE ONLY)
Batch Number:
Date:
Initial:
Cash
Credit Card
Vision: Pass
Fail
Check
Money Order
Payment Type:
- Please complete REQUIRED Voter Registration and SIGNATURE Section on reverse side-
T21053-0807
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