State of Montana
IDENTIFICATION CARD (all applicants)
Print in BLACK or BLUE ink only | Customer Care Center: (406) 444-3933
11-1400 (10/20)
MCA 61-5-107 and USC 666(a)(13)
For Ocial Use Only:
Last Name First Name Middle Name Sux
Legal Last Name Legal First Name Legal Middle Name Sux(Jr., Sr., 1
, etc.)
Date of Birth (mm/dd/yyyy) Sex Eye Color Weight Height Hair Color Are you a Montana Resident
Residential Address City State Zip Code
Mailing Address City State Zip Code
Choose which address will be printed on your driver license.
For REAL ID, you must select a residential address. Residential Mailing
Are you a United States Citizen? Place of Birth: City/State/Province/County
Yes No
Driver License/ID Card Number State Social Security Number
Daytime Phone Number Email Address
Add a veteran designation to your license (verication of eligibilty required, more info atairs)
I choose not to have Montana scan any non-REAL ID documents I have provided.
Are you applying for REAL ID? (also applies if you already have a REAL ID and wish to keep or remove the designation)
Yes No
Driver License (Class D) Motorcycle Endorsement Identication Card (skip questions 1-5) Replacement
1. Do you have any physical or mental condition that impairs or may impair your ability to exercise
ordinary and reasonable control in the safe operation of a motor vehicle on the highway? >>>>
2. Do you rely on any adaptive equipment or operational restrictions to attain the ability to exercise
ordinary and reasonable control in the safe operation of a motor vehicle on the highway? >>>>
3. Do you suer from any chronic or potentially chronic condition that may cause a loss of conscious-
ness or control? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
4. In the past 10 years, have you held a valid driver license or commercial driver license from any
jurisdiction (state) other than Montana?
If yes, list all states:
5. Do you have a current or pending suspension, revocation, cancellation, disqualication, or with-
drawl of your driver license or privilege to drive by the State of Montana or by another state or
jurisdiction? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Yes No
Yes No
Yes No
Yes No
Yes No
<<<<<<<<<<<<< Please continue to the other side >>>>>>>>>>>>>
Yes No
11-1400 (10/20)
MCA 61-5-107 and USC 666(a)(13)
If you are 15 or older, do you want your driver license or ID to show that you are an organ donor?
If you are 18 or older, do you want your driver license or ID to show that you have a living will?
If you are under age 26 but at least age 15, do you consent to registration with the Selective
Service System, if required by federal law? (If under 18, you will be registered upon attaining
age 18). >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
I certify under penalty of law that the information I provided is true and correct, except for my answer about sex,
to the best of my knowledge, information, and belief. I understand that any false or misleading statement on my
application may result in criminal prosecution, cancellation of any license or card issued and/or my disqualication
for a period of 60 days. I understand information may be veried against nationwide systems. I understand that if
Montana issues me a driver license or ID, any other card held in another state will be canceled. I understand that if
I am issued any other driver license or ID by any other state Montana will cancel all driver licenses or IDs issued by
Signature: Date
I want to register to vote or update my voter registration (continue on with application if selected)
I Do not want to register to vote (end of application if selected)
I’m already registered to vote and do not want to update my information (end of application if selected)
County you are residing in:
Are you a citizen of the United States? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Will you be at least 18 years of age on or before the next election? >>>>>>>>>>>>>>
Will you be a Montana resident for at least 30 days before the next election? >>>>>>>>
If you checked “No” in response to any of these questions, this is the end of the application.
Previous 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.
Previous Registration Name Residence Address of previous registration
Previous City Previous County Previous State Previous Zip Code
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 if I le a change of address with the U.S. Postal
Service, I must complete, sign, and return a conrmation notice mailed to me by the county election oce.
Voter Application Armation
I arm 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 ne 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 armation on this application for voter registration must be signed by the applicant. Failure to do so will prevent
the application from being processed.
Where you submit this form and your decision to not vote is condential, 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 nd the location and directions to your polling place at:
Yes No
Yes No
Yes No Not Applicable
Yes No
Yes No
Yes No