Fillable Application for Change of Address or Replacement on (U.S. State of Texas)

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Application for Change of Address or Replacement on (U.S. State of Texas)

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DL-64 7/2020
DO NOT MAIL CASH
Mail check or money order payable to:
Texas Department of Public Safety
MAIL COMPLETED FORM AND $10 FEE TO:
Texas Department of Public Safety, PO Box 149008, Austin, Texas, 78714-9008
Are you a citizen of the United States? Yes No
If you are not a U.S. citizen, you must apply at the local driver license ofce to change your address or obtain a replacement DL or ID card.
Driver License Number Identication Card Number
Date of Birth MM/DD/YYYY Phone Number
Social Security Number Sufx (SR., JR., etc.)
Last Name
First Name
Middle Name / Birth Surname
Residence – Street Address (Address cannot be a post ofce box or business address)
City
County State Zip Code
Email
Mailing – Street Address or Post Ofce Box
City
County State Zip Code
Do you want a Veteran designator on your DL or ID, or are you 50% disabled or are you 40% and have had a lower extremity amputated and want a Disabled Veteran
designator on your DL or ID? If yes, select one: Veteran Disabled Veteran
(Proof of honorable discharge required; some acceptable documents are DD214/215, NGB22, VA disability letter, Veteran Identication card, proof of service/verication of
honorable service card. Proof of disability is required for Disabled Veteran designator)
If you want a Veteran or Disabled Veteran designator, do you also want the branch of service shown on your DL or ID?
If yes, select one: Army Air Force Coast Guard Marines Navy
Information on the front and back of this form must be completed before submitting.
Do you want to support the Glenda
Dawson Donate Life Texas Donor
registry? If yes, please indicate a
donation amount of $1 or more.
$_______.00
Yes No
Would you like to register as an organ
donor?
Yes No
Do you want to support Texas
Veterans? If yes, please indicate your
donation amount. $_______.00
(This donation does not apply to
CDL holders)
Yes No
Do you want to support survivors of
sexual assault? If yes, please indicate
a donation amount of $1 or more to
help fund the testing of sexual assault
evidence collection kits (rape kits).
$_______.00
Yes No
Do you want to support the issuance of
a DL/ID for foster or homeless youth?
If yes, please indicate a donation
amount of $1 or more $_______.00 to
exempt this population from paying any
fees.
(This donation does not apply
to CDL holders)
Yes No
Application for Change of Address or Replacement on valid Texas Driver
License (DL), Commercial Driver License (CDL) & Identication Card (ID)
DL-64 7/2020
No Waiting in Line! – Change your address online
Visit our Website at https://www.texas.gov/driver
I understand that giving false information to procure a voter registration is perjury, and a crime under state and federal law. Conviction
of this crime may result in imprisonment up to 180 days, a ne up to $2,000, or both. PLEASE READ ALL THREE STATEMENTS TO
AFFIRM BEFORE SIGNING.
I am a resident of the county provided above, and a U.S. citizen; I have not been nally convicted of a felony, or if a felon, I have completed all
of my punishment including any term of incarceration, parole, supervision, period of probation, or I have been pardoned; And I have not been
determined by a nal judgment of a court exercising probate jurisdiction to be totally mentally incapacitated or partially mentally incapacitated
without the right to vote.
By providing my electronic signature, I understand the personal information on my application form and my electronic signature will be used for
submitting my voter’s registration application to the Texas Secretary of State’s ofce. Wanting to register to vote, I authorize the Department of
Public Safety to transfer this information to the Texas Secretary of State.
In the event of injury or death would you like to provide two (2) emergency contacts? If yes, please list:
a) Name Telephone Number
Address
b) Name Telephone Number
Address
If you currently hold a valid Texas non-commercial driver license or identication card and have not reported your change of address as required
by TRC 521.054 and Administrative Code 15.25, you may do so by mail or on the Internet. To report a change of address by mail, complete
this form and mail along with the required fee(s) to the Texas Department of Public Safety. To report a change of address online, go to
https://www.texas.gov/driver. A driver license or identication card validating your reported address change will be mailed to you.
This form may ONLY be used to change your address or obtain a replacement DL or ID card. If you need to change information other than your
address or desire a new photo, you must apply at the local driver license ofce.
United States Selective Service
Any male at least 18 but younger than 26 years of age submitting this application consents to registration with the United States Selective Service
System. Alternative options for those who object to conventional military service for religious or other conscientious reasons may be found at:
https://www.sss.gov/About/Alternative-Service. By submitting this application, I am consenting to registration with the United States Selective
Service System if my registration is required by federal law.
If you are a U.S. citizen, would you like to register to vote? If registered, would you like to update your voter information?
Yes No
Would you like to be an Election Judge?
Yes No
CERTIFICATION
I do solemnly swear, affirm, or certify that I am the person named herein and that the statements on this application are true and
correct. I further certify my residence address is a (select one): single family dwelling, apartment, motel, temporary shelter.
I agree to immediately report to the Texas Department of Public Safety any changes in my medical condition which may affect my ability to
safely operate a motor vehicle. I further understand that I am required by law to report any change of name or address to the Department of
Public Safety within thirty days.
Signature of Applicant _____________________________________________________ Date _________________________
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Application for Change of Address or Replacement on (U.S. State of Texas)

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Completed 15 July 2020

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