Place of Birth: City Place of Birth: State/Province/Country
Application
P.O. Box 201430, Helena, MT 59620-1430 Phone (406) 444-3933 Fax (406) 444-1631 www.dojmt.gov DriverLicense@mt.gov
Please PRINT.
Montana state authorities reserve the right to reject any form that has been altered.
21-1304 (6/17) Page 1 of 2 This form is available in alternate formats for people with disabilities.
Last Name__________________
First Name__________________
DOB_______________________
DL #_______________________
Motorcycle Skills Waiver Provisions
Drivers who complete the Motorcycle Safety Foundation Basic Rider Course (MSFBRC) outside the State of Montana may qualify for
waiver of the motorcycle skills test to add the motorcycle endorsement to their license if the following is met.
• The organization and instructor that conducted the MSFBRC were currently certified when the course was given.
• The rider is applying for the skills test waiver within one year of successfully completing the course.
• The rider provides proof of successful completion within the past year by completing the following information.
Suffix (Jr., Sr., 1
st
, etc.)
Date of Birth (mm/dd/yyyy)
Montana Residential Address
Which address would you like printed on your driver license? MT Residential Address MT Mailing Address
US address to mail license (cannot mail out of country)
Are you a United
States Citizen?
Montana Driver License Number
Current Daytime Phone Number
I affirm under penalty of law (MCA 61-5-303) that the information on this application is true and correct to the best of my knowledge, information, and belief.
Do you want to register to vote in Montana, or if already registered, do you want to update your voter registration?
Yes
(continue on) No
(end of application)
County
you are registering to vote in:______________________________________________
Ar
e you a citizen of the United States? Yes No
Will you be at least 18 years of age on or before the next election? Yes No
Will you be a Montana resident for at least 30 days before the next election? Yes No
If you checked “No” in response to any of these questions, this is the end of the application.
Prev
ious Registration Information – will be used to provide cancellation information to former jurisdiction. Required if name changed or if previously
registered to vote in another MT county or in another state.
Receive Your Ballot in the Mail
Yes, I request an absentee ballot to be mailed to me for all elections in which I am eligible to vote as long as I reside at the address listed on this
application. I understand that in order to continue to receive an absentee ballot, I must complete, sign, and return an address confirmation notice mailed to
me by the county election office in January of each even-numbered year.
Voter Applicant Affirmation
I affirm under penalty of perjury that the information on this application is true, that I am a citizen of the United States, that I will be at least 18 years old on
or before the next election, that I will have been a resident of Montana for at least 30 days prior to the next election, and that I am not serving a felony
conviction in a penal institution nor have been found to be of unsound mind by a court. I understand that if I have given false information on this application,
I may be subject to a fine or imprisonment, or both, under federal and/or state law. By signing you authorize the Motor Vehicle Division to use your electronic
signature for voter registration purposes.
Signature Date
The aff
irmation on this application for voter registration must be signed by the applicant. Failure to do so will prevent application from being processed.
Wher
e you submit this form and your decision to not vote is confidential, and this information can only be used for voter registration purposes.
You can visit the Montana Secretary of State “My Voter Page” to check if you are registered to vote, check your voter registration address, and find the
location and directions to your polling place at: https://app.mt.gov/voterinfo/.
Previous Registration Name
Residence Address of Previous Registration
Are you a Montana Resident?
Yes No
