Fillable D1 STATE OF ALASKA DIVISION OF MOTOR VEHICLES (State of Alaska)

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D1 STATE OF ALASKA DIVISION OF MOTOR VEHICLES (State of Alaska)

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Country of origin: US
File type: PDF

U.S.A. forms for State of Alaska

BROWSE STATE OF ALASKA (AK) FORMS

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ALASKA LICENSE/ID NUMBER NONE
DATE OF BIRTH
FIRST NAME MIDDLE NAME LAST NAME SUFFIX
MAILING ADDRESS CITY STATE ZIP
RESIDENCE ADDRESS (Printed on Card) CITY STATE ZIP
1. Are you a United States cizen? YES NO
2. If you marked no to the previous queson, are you a United States naonal? YES NO
3. Would you like to be an organ donor? (Selecng no will cancel your current organ donor status, if applicable.) YES NO
4. Have you ever been known by a dierent legal name? YES NO
Name(s): _______________________________________________________________________________________
5. Within the last 10 years, have you held a permit or driver’s license in another state? YES NO
Date(s) and State(s): ______________________________________________________________________________
6. Have your driving privileges ever been suspended or revoked, and/or have you had a driving applicaon denied? YES NO
Date(s) and Reason(s): ____________________________________________________________________________
7. Within the past ve years, have you had a medical condion or impairment, mental or physical disorder, seizure, YES NO
or any other serious health problem that could aect your ability to safely operate a motor vehicle?
Explanaon: ____________________________________________________________________________________
8. Would you like to register to vote or make changes to your voter registraon? YES NO
9. If you marked yes to the previous queson, do you meet the eligibility requirements to register to vote? YES NO
Voter Registraon Informaon: To register to vote, you must be a US Cizen, an Alaska resident, and 18 years of age or older, or within 90 days of turning 18. If you
decline to register to vote, the fact that you have declined to register will remain condenal and will be used only for voter registraon purposes. If you register to
vote, the oce at which you submit this voter registraon applicaon will remain condenal and will be used only for voter registraon purposes. To vote, you
cannot be under 18, registered in another jurisdicon, judicially determined to be of unsound mind, or convicted of a felony involving moral turpitude, unless, having
been so convicted, you have been uncondionally discharged from incarceraon, probaon, and/or parole.
STATE OF ALASKA DIVISION OF MOTOR VEHICLES
DRIVER LICENSE, PERMIT OR IDENTIFICATION CARD TRANSACTION APPLICATION
PERSONAL INFORMATION
SEX
D1
SOCIAL SECURITY NUMBER NONE
HEIGHT (FEET/INCHES) WEIGHT (LBS) HAIR COLOR EYE COLOR
BIRTH CITY BIRTH STATE BIRTH COUNTRY
ADDITIONAL DRIVER AND VOTER INFORMATION
EMAIL ADDRESS PHONE NUMBER
REAL ID COMPLIANT
STANDARD
Standard cards may not
be used for commercial
air travel aer 5/3/23.
IDENTIFICATION CARD
DRIVER LICENSE
INSTRUCTION PERMIT
NON-COMMERCIAL
COMMERCIAL
MOTORCYCLE
OTHER __________
CLASS A
CLASS B
CLASS C
PASSENGER
SCHOOL BUS
DOUBLES/TRIPLES
TANK
HAZARDOUS MATERIALS
FEDERAL LIMIT
SELECTION
CARD TYPE(S) LICENSE AND/OR
PERMIT TYPE
COMMERCIAL
CLASS
COMMERCIAL
ENDORSEMENT(S)
OPTIONAL CARD
DESIGNATORS
ORGAN DONOR
VETERAN
HIDDEN DISABILITY
I. I cerfy under penalty of perjury that all informaon provided on this applicaon is true. False statements are punishable under AS
11.56.210 and AS 15.56.050.
II. I acknowledge that by receiving an Alaskan credenal, any other credenal from another state may be cancelled or invalidated.
III. I understand the type of license(s) that are available to me and I have chosen the license that I would like.
IV. If I made an anatomical gi, I understand the informaon on my license will be transmied to a donor registry created under AS 13.50.110.
V. I understand it is my responsibility to nofy DMV if my license is destroyed or mulated or if my anatomical gi is revoked under AS
13.52.183.
VI. If I registered to vote using this form, I meet the requirements to register to vote, I will meet the requirements to vote, and I am not regis-
tered to vote in another jurisdicon or I agree to cancel that registraon.
_____________________________________________________________________________
APPLICANT PRINTED NAME
_____________________________________________________________________________ ________________ __________________
APPLICANT SIGNATURE DATE LDAP/OFFICE (DMV)
APPLICANT SIGNATURE
LDAP/OFFICE: ______________________________________________
DATE: ____________________________________________________
BATCH #: __________________________________________________
PAYMENT TYPE: _____________________________________________
DOCUMENTS ACCEPTED: _____________________________________
ADDITIONAL INFORMATION: __________________________________
__________________________________________________________
VISION TEST RESULTS: Le: 20/_____ Right: 20/_____ Both: 20/_____
Correcve Lenses: Yes No
Color Blind Test: Pass Fail
Other Vericaon: Med Card Doctor’s Note
KNOWLEDGE TEST(S): General Motorcycle Alcohol
CDL General Tank Double/Triple Air Brake
HAZMAT Passenger School Bus Combo
ROAD TEST(S) PASSED: Standard Commercial
DMV USE SECTION
FORM REVISION DATE: FEB 2022
NAME OF PARENT, LEGAL GUARDIAN OR RESPONSIBLE ADULT
By signing below, I cerfy that I am eligible to authorize this minor for the applicable credenal, as pursuant to AS 28.15.071, and if this minor is
applying for a provisional license, they have had at least 40 hours of driving experience, including at least 10 hours in progressively challenging
circumstances. I understand that I am liable for damages caused by the minor when driving a motor vehicle and I may le a wrien request with
DMV to cancel the license or permit.
__________________________________________________________________________ _________________ _______________________
ADULT SIGNATURE (MUST BE SIGNED IN FRONT OF NOTARY OR DMV) DATE IDENTITY DOCUMENT #
__________________________________________________________________________ _________________ _______________________
NOTARY PUBLIC OR DMV REPRESENTATIVE DATE COMMISSION EXPIRATION
NOTARY STAMP:
CONSENT FOR MINOR APPLICANTS
RELATIONSHIP TO APPLICANT
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D1 STATE OF ALASKA DIVISION OF MOTOR VEHICLES (State of Alaska)

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Completed 18 April 2022

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