Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Website: dmvnv.com
Application for Alternate Address
This application is used to request an alternate Nevada physical address be printed on the face of a driver’s license or
identification card pursuant to Chapter 483 of NRS. This application must be approved by a DMV representative and
additional documents may be requested to support this application.
Actual Residential Address
Mailing Address if Different
Badge, Agency ID or Court Order Number (If applicable)
I, , do hereby certify that I am:
Justice/judge; senior justice/judge; court appointed master; clerk of a court, court administrator or court executive officer, in this State
District attorney or attorney employed by such, whose normal job duties prosecute persons for: category A felonies or domestic violence.
State/County public defender whose normal job duties defend persons for: category A felonies or domestic violence.
Peace Officer as defined by NRS 289.150 to NRS 289.360, inclusive
Retired Peace Officer as defined by NRS 289.150 to NRS 289.360, inclusive
Any person, without limitation, a social worker, employed by or in a political subdivision of this State whose normal job duties: interact with
the public and performs tasks related to child welfare or protective services or tasks that expose the person to comparable dangers.
County manager in this State.
Spouse, domestic partner or minor child of a person with a previously mentioned position or title
Surviving spouse, domestic partner or minor child of a person with a previously mentioned position or title, who was killed in the
performance of their duties.
Person authorized to suppress a residential address by state/federal law or a court order (copy must be provided)
Requested Alternate Address:
A Post Office Box will not be permitted. A Peace Officer’s alternate address must be the street address of his or her employer.
Person of Authority is defined as someone who is authorized to verify employment for the above named individual.
*If you are a spouse, domestic partner, or minor child, the below portion must be completed by the individual to whom you are related
which qualifies for the alternate address.
**If you are a surviving spouse, domestic partner, or minor child, the below portion must be completed by someone who can validate
the decedent’s employment which qualifies you for the alternate address.
Badge, Agency ID or Court Order Number
I hereby certify, under penalty of perjury, that all statements in this application are true and correct. I agree and understand
any misstatement of material facts may cause cancellation and/or denial of my driver license or identification card under NRS
483.420 and NRS 483.530, respectively. I further understand any misstatement of facts may be a misdemeanor or felony under
NRS 483.530, and may be punishable pursuant to NRS 193.130.
Applicant Signature Date
(DMV007, Rev. 7/19)
