STATE OF ALASKA DIVISION
OF M
OTOR
VEHICLES
APPLICATION FOR ALASKA DRIVER LICENSE,
PERMIT OR IDENTIFICATION CARD
Form 478 (revised 12/2019) Page 1
Alaska License / Permit / ID Number
Social Security Number (AS 28.15.061)
I have never been assigned a SSN (SSA letter required)
ft in lbs
State / Country (if other than US)
(This is where the card will be mailed)
(Physical location where you live)
Can we contact you via e-mail?
Yes No
Please print my residential
address on card:
1. Are you a U.S. Citizen? U.S. National
2. Would you like to register to vote or make changes to your current voter registration?
3. Have you ever been known by different legal name? (If yes, please provide all previous names below):
4. Do you currently hold a license, permit, or ID in another state? (If yes, please provide your current license information):
License Number: Federally Compliant (Real ID)
Standard (Not Real ID)
5. Have you ever held a license, permit, or ID in another state? (If yes, please provide the states below):
What are you applying for? Federally Compliant Card (Real ID) Standard Card (Not Real ID)
Type of License / Permit / ID
Non-Commercial Driver License (D)
Motorcycle Permit (IM)
Motorcycle License (M1) or (M3)
Identification Card (ID)
Commercial Driver License*: A B C
Commercial Learner’s Permit*: IA IB IC
Other: __________________
*Additional information is required for Commercial applicants on Form 413
Proof of eligibility required)
VETERAN (Proof of honorable discharge required)
Organ Donor
I would like to donate $_________ to the
anatomical gift awar
eness fund.
School Bus (S)
Doubles / Triples (T)
Hazardous Materials (H)
Tank (N)
HazMat (H) + Tank (N) = (X)
Tell us about your driving history: (Only necessary to complete if you’re applying for a license or permit.)
6. Have your driving privileges ever been suspended or revoked, or has your application ever been denied?
(If yes, please
provide the reason, state, and date of the suspension, revocation, or denial below):
7. Within the past 5 years, have you had a medical condition or impairment, mental or physical disorder, seizure, or any
other serious health problem that could affect your ability to safely operate a motor vehicle? (If yes, please explain below):
DO NOT SIGN UNTIL DIRECTED BY A DMV REPRESENTATIVE
I acknowledge that receiving an Alaska Permit, License or ID card may cancel or invalidate any Permit, License or ID card from another state per the laws of that state. I
certify that I understand the options for driver’s license and identification card types available today and have knowingly selected the type indicated on this form. I certify
that other than the credential I am surrendering today, I do not have a driver’s license or Real ID credential in another state. I have personally reviewed the information on
this application and certify under penalty of perjury that to the best of my knowledge and belief the information on this application is true and correct.
NOTE: Making a false statement in connection with this application may be punishable by a maximum penalty of $50,000 or five years imprisonment or both per AS 11.46.505.