Fillable Application for Driving Privilege or ID Card By

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Application for Driving Privilege or ID Card By

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555 Wright Way, Carson City, NV 89711
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Rural Nevada (877) 368-7828
Fax (775) 684-4829
Website: www.dmvnv.com
DMV 204E (Revised 6/2020)
Application for Driving Privilege or ID Card By Mail
NRS 483.347, NRS 483.383-483.384, NAC 483.456-483.4595
Nevada residents who meet all Department requirements may use this form to apply for a driver’s license renewal or duplicate by mail. Only one renewal may
be completed by mail in consecutive renewal periods. If you are unsure about your eligibility to renew by mail, please contact the Driver’s License Renewal
by Mail Section at one of the above telephone numbers before submitting your application.
If you are no longer a resident of Nevada, surrender your Nevada driver’s license to the Department of Motor Vehicles in the state where you now reside and
apply for a driver’s license in that state.
Complete this form and mail it to the DMV address noted above with the appropriate fees in the form of a check, money order or debit/credit card authorization
(form ADM205. Do NOT send cash. Fees are outlined on the DMV website at http://www.dmvnv.com/dlfees.htm.
US Government employees, active duty military, or dependents of such persons who wish to renew their license must submit a copy of an employment or
military record (leave/earnings statement) indicating Nevada as your state of residence. Active duty military personnel are not subject to late penalty fees for a
driver’s license expired over 30 days and are eligible to renew by mail up to 2 years after expiration. Please contact us for eligibility requirements.
LAST NAME (PRINT)
FIRST NAME
MIDDLE NAME
SUFFIX
NEVADA DL/DAC/ID NUMBER
DATE OF BIRTH
FULL LEGAL NAME ON BIRTH CERTIFICATE
PLACE OF BIRTH (STATE AND COUNTRY)
HEIGHT
FT. IN.
WEIGHT
LBS.
HAIR COLOR
EYE COLOR
MOTHER’S MAIDEN NAME
YES, print my mailing address on the front of my card (Except Real ID)
PRIMARY PHYSICAL ADDRESS (PRINCIPAL RESIDENCE)
MAILING ADDRESS (WHERE YOU WANT YOUR CARD MAILED)
CITY, STATE, ZIP CODE
CITY, STATE, ZIP CODE
DAYTIME PHONE NUMBER (OPTIONAL)
( )
EMAIL ADDRESS (OPTIONAL)
CITIZEN
Are you a United States citizen?
YES NO
SELECTIVE
SERVICE
If you were born male and are at least 18-26 yrs. old and DO NOT check the box, you will be
registering for Selective Service. You will remain eligible for federal student loans, grants, benefits
relating to job training, most federal jobs and, if applicable, citizenship in the United States.
NO, I am not
eligible or do not wish
to register
VETERAN
1
I have a U.S. Armed Forces honorable discharge and wish to have a veteran designation
placed/retained on my license. If your card does not already have a veteran designation, you must
present proof of honorable discharge.
YES NO
2
Have you ever served on active duty in the Armed Forces of the United States and separated from
such service under conditions other than dishonorable?
YES NO
3
Have you ever been assigned to duty for a minimum of 6 continuous years in the National Guard or a
reserve component of the Armed Forces of the United States and separated from such service under
conditions other than dishonorable?
YES NO
4
Have you ever served the Commissioned Corps of the United States Public Health Service or the
Commissioned Corps of the National Oceanic and Atmospheric Administration of the United States in
the capacity of a commissioned officer while on active duty in defense of the United States and
separated from such service under conditions other than dishonorable?
YES NO
ORGAN DONOR
Would you like to be an organ donor and have that indicated on your license or identification card?
YES NO
If you would you like to donate $1 or more to the anatomical gift account, indicate how much here: $______________
DRIVING
HISTORY
Has your driving privilege ever been revoked, suspended, canceled or denied?
If yes, from which State(s): Date: Reason:
YES NO
MEDICAL
HISTORY
Do you have a disability or missing extremity?
YES NO
YES NO
Do you have any illness or take any medication that could affect your driving ability?
YES NO
If you answered YES to either question, please explain:
NOTE: Some medical conditions may be indicated on your DL/DAC/ID. Form DLD7 must be completed by a physician.
DMV 204E (Revised 6/2020)
ALL APPLICANTS MUST COMPLETE SECTION 1 OR SECTION 2
SECTION 1
By checking this box, you affirmatively decline the transmission of your information for voter registration/update
purposes.
NOTE: Opting out of this process will not change your current voter registration preferences.
OPT - OUT
SECTION 2
NOTE: Do not complete this section if you chose to opt-out by checking the box above. If both sections are completed, this entire
application will be labeled as incomplete and not processed.
VOTER
REGISTRATION
Are you 18 years or older?
YES NO
Are you currently 17 and would like to preregister? You will be able to vote when you turn 18.
YES NO
If you are eligible, you will be registered to vote or have your voter registration updated. Unless you opt-out,
we will send your information to your County Clerk/Registrar. If you had a felony conviction, you are eligible to vote
on release from prison. Your choice to register to vote or not and the place where you register are confidential and
will not affect the assistance or services provided to you by the DMV. Nevada Revised Statute Chapter 293.
If applicable, check one of the following: (The Uniformed And Overseas Citizens Absentee Voting Act)
Domestic Military (or military spouse or dependent) on active duty and absent from Nevada voting residence
Overseas Military (or military spouse or dependent) on active duty and absent from Nevada voting residence
Overseas Citizen residing outside the U.S. (not applicable to those traveling/vacationing outside the U.S.)
Political Party Selection – Check Only One Box
Democratic Party Independent American Party Libertarian Party
Nonpartisan (no party affiliation) Republican Party
Other Party – Write in here: ________________________________________________________
A voter registration record must indicate a major political party in order to vote for candidates in a primary election.
A new voter registration record will default to “nonpartisan” (no political party) unless a political party is indicated
above. If you are already registered to vote in Nevada, no party selection during this transaction will result in your
record using your previous political party preference.
If you are active duty military residing outside of Nevada and you do not have an active Nevada physical address,
indicate which County you would like your voter registration information to be forwarded to.
COUNTY: _________________________
Voter registration applications are also available in Spanish and Tagalog and can be found on the DMV website:
https://dmvnv.com
I hereby certify, under penalty of perjury, that all statements in this application are true and correct. I attest that I am a legal
resident of Nevada. I understand that any misstatement of facts on this application may cause the cancellation or denial of my
driver’s license pursuant to NRS 483.420. “I swear or affirm I am a U.S. citizen. I will be at least 18 years old by the date of the
next election, or I am at least 17 years old. I will have continuously resided in Nevada at least 30 days in my county and at least
10 days in my precinct before the next election at which I intend to vote. The physical address listed herein is my sole legal
place of residence and I claim no other place as my legal residence. If I am preregistering to vote, I understand and acknowledge
that I will be deemed to have registered to vote as of the date of my 18th birthday unless my preregistration is cancelled by any
of the means or for any of the reasons for cancelling voter registration pursuant to Chapter 293 of the Nevada Revised Statutes. I
am not currently serving a term of imprisonment for a felony conviction. I declare under penalty of perjury that the foregoing is
true and correct.”
Applicant Name _________________________________________ DL/ID/DAC Number ________________________
Applicant Signature ______________________________________ Date _______________________
DMV 204E (Revised 6/2020)
ALL RENEWAL APPLICANTS MUST ALSO HAVE THIS SECTION COMPLETED
Certificate of Vision Examination
This section must be completed for every person applying to renew a Nevada driver’s license. You may have this report completed by a
licensed physician, ophthalmologist, optician, optometrist, or driver’s license issuing agency in your area. The form must be dated within the
past 90 days and signed by the person who administered the exam. It also needs to show separate visual acuity readings for the right, left
and both eyes, and indicate whether the exam was taken with or without corrective lenses. A prescription for corrective lenses cannot be
accepted in lieu of the required vision examination.
Vision Without Corrective Lenses With Corrective Lenses
Right Eye ...................................................................... 20/ 20/
Left Eye ........................................................................ 20/ 20/
Both Eyes ..................................................................... 20/ 20/
Does this person have a progressive disease or condition of the eye? Yes No
_______________________________________________________ _______________________________________
Signature: Driver’s License Issuing Agency/Physician/Optometrist Date of Examination (must be within the last 90 days)
_______________________________________________________ ( ) ________________________________
PRINTED Name: Issuing Agency/Physician/Optometrist Area Code and Phone Number
___________________________________________________________________________________________________
PRINTED Office Address: Issuing Agency/Physician/Optometrist
RENEWAL APPLICANTS 71 OR OLDER MUST ALSO HAVE THIS SECTION COMPLETED
Physical Evaluation
All renewal applicants who will be 71 years of age or older on their driver’s license expiration date must have this report completed,
signed, and dated by a licensed physician no more than 90 days before it is submitted to the Nevada DMV.
Does a medical condition exist that would prevent this patient from safely operating a motor vehicle? ........ Yes No
If “Yes,” please explain: __________________________________________________________________________
Is this patient taking any medication that would negatively affect his/her ability to drive safely? ................... Yes No
If “Yes,” please explain: __________________________________________________________________________
_________________________________ ____________________ _________________________________
Physician’s Signature Physician’s License Number Date of Physical Evaluation
(must be within the last 90 days)
_______________________________________________________ ( ) __________________________
PRINTED Name of Physician Area Code and Phone Number
___________________________________________________________________________________________________
PRINTED Office Address of Physician
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Completed 3 September 2020

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