Fillable Form Dl 1p - Driver'S License And Identification Card Application printable pdf download

Completion of this section is requested but not required to apply for a driver's license or ID Card. (Virginia Code §2.2-3806)

INFORMATION FOR THE DEPARTMENT OF ELECTIONS

Are you a citizen of the United States of America?

Do you want to apply to register to vote or change your voter registration

address?

YES

(INITIAL BOX)

INFORMATION FOR THE VIRGINIA TRANSPLANT COUNCIL

Yes, I would like to become an organ, eye and tissue donor.

DL 1P (07/01/2016)

DRIVER'S LICENSE AND IDENTIFICATION CARD APPLICATION

LOG #

Purpose:

Use this form to apply for a driver's license or identification card.

Instructions: Submit completed application to any DMV Customer Center. Complete front and back of this application.

Note: A $5 service fee applies to each license or identification card renewal conducted in a Customer Service Center (CSC) if the transaction is

eligible to be performed by internet or mail, unless the renewal is conducted with another transaction that must be completed in person at a CSC.

APPLICATION TYPE (Check one)

Driver's License

Motorcycle Learner's Permit

Identification (ID) Card

(classification not applicable)

Driver's License with School Bus Endorsement

Learner's Permit and Driver's License

Hearing Impaired ID Card

(to carry less than 16 passengers)

Driver's License with Motorcycle

Driver's License Testing for Foreign Diplomats

Emancipated Minor ID Card

(complete Motorcycle Classification section below)

Motorcycle Only License

(complete Motorcycle Classification section below)

Motorcycle Classification

Maintaining current Virginia Motorcycle Classification

Add, Upgrade or Transfer Motorcycle Classification or obtain Motorcycle Only License. Additional testing may be required. Check applicable box below.

M 3 (3 wheels)

M (both 2 and 3 wheels)

M 2 (2 wheels)

Replacement License or Identification Card

I am surrendering my current license or ID card as it has been Destroyed or Mutilated

(check one of the following)

I certify I cannot surrender my current license or ID card because it is:

Lost

Stolen

Do you currently have or have you ever held a driver's license or learner's permit from another state, U.S. territory or foreign country?

Yes

If yes, provide the following:

LICENSE NUMBER

ISSUE DATE (mm/dd/yyyy)

EXPIRATION DATE (mm/dd/yyyy)

STATE/COUNTRY

APPLICANT INFORMATION

NOTE:

YOUR ADDRESS BELOW MUST BE CURRENT. THE U.S. POSTAL SERVICE WILL NOT FORWARD YOUR LICENSE OR ID CARD.

FULL LEGAL NAME (last, first, middle, suffix)

SOCIAL SECURITY NUMBER

BIRTHDATE (mm/dd/yyyy)

TELEPHONE NUMBER

GENDER (check one)

WEIGHT

HEIGHT

EYE COLOR

HAIR COLOR

MALE

FEMALE

LBS.

FT.

IN.

STREET ADDRESS

APT NO.

CITY

STATE

ZIP CODE

NAME OF CITY OR COUNTY OF RESIDENCE

IF YOUR NAME HAS CHANGED, PRINT YOUR FORMER NAME HERE

CITY

COUNTY OF

MAILING ADDRESS (if different from above - this address will show on your license/permit)

APT NO.

CITY

STATE

ZIP CODE

SPECIAL INDICATOR REQUEST

1. Do you wear glasses or contact lenses to operate a motor vehicle?

YES

Please show the following indicator(s) on my

2. Do you have a physical or mental condition which requires that you take medication?

YES

license or ID card:

Insulin-dependent diabetic

3. Have you ever had a seizure, blackout, or loss of consciousness?

YES

Speech impairment

4. Do you have a physical condition which requires you to use special equipment to drive?

YES

Hearing impairment (license only)

5. Have you been convicted within the past ten years in this state or elsewhere of any offense

Intellectual disability (IntD)

YES

resulting from your operation of, or involving, a motor vehicle?

(Do not include parking tickets.)

Autism spectrum disorder (ASD)

6. Has your license or privilege to drive ever been suspended, revoked, or disqualified in this state or

YES

Must submit required physician statement

elsewhere, or is it currently suspended, revoked or disqualified?

If you answered YES to any of the above provide an explanation here.

FOR DMV USE ONLY — DO NOT WRITE BELOW THIS LINE

REQUIRED TESTS

PASS

FAIL

CUSTOMER NUMBER

TRANSACTION TYPE

FEE

ORIGINAL

REISSUE

REPLACEMENT

RENEWAL

VISION

DL KNOWLEDGE EXAM

PROOF OF ID (primary)

PROOF OF ID (secondary)

DL ROAD SIGNS EXAM

DL SKILLS

PROOF OF SOCIAL SECURITY (specify)

PROOF OF RESIDENCY

MC KNOWLEDGE

MC SKILLS M2

PROOF OF LEGAL PRESENCE (specify)

MC SKILLS M3

Document Type

Document Number

Expiration Date (mm/dd/yyyy)

REMARKS/PAID STAMP

Document Type

Document Number

Expiration Date (mm/dd/yyyy)

Document Type

Document Number

Expiration Date (mm/dd/yyyy)

CSR SIGNATURE AND LOGONID

DOCUMENT VERIFIER SIGNATURE AND LOGONID

Form Dl 1p - Driver'S License And Identification Card Application

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