DL-14A (Rev. 1/20)
DL-14A - TEXAS DRIVER LICENSE OR IDENTIFICATION CARD APPLICATION
(ADULT - 17 YEARS 10 MONTHS OF AGE AND OLDER)
NOTICE: All information on this application must be in INK. Applications held for 90 days only.
DPS CANNOT REFUND PAYMENT ONCE APPLICATION IS SUBMITTED.
FOR DEPARTMENT USE ONLY
RESTRICTIONS/ENDORSEMENTS
ASSIGNED # ___________________
Application for: _____ Driver License _____ Identification Card Class (select one): ___ A ___ B ___ C Motorcycle: ___ Y ___ N
Select one: _____ Original _____ Renewal _____ Replacement _____ Address or Name Change
APPLICATION CONTINUED ON BACK
APPLICANT INFORMATION
Last Name:_________________________________________ First Name:_________________________________________ Middle Name: ___________________________
Suffix:__________________________________ Birth Surname (Maiden):_________________________________________ SSN: _______________________________
Date of Birth
(mm/dd/yyyy)
:_____________________ Sex (select one): ___ Male ___ Female Height: ______ Ft. ______ In. Weight: __________ Lbs.
Eye Color (select one): ____ Blue ____ Brown ____ Gray ____ Hazel ____ Green ____ Black ____ Maroon ____ Pink
Hair Color (select one): ____ Black ____ Red ____ Gray ____ Brown ____ Blonde ____ Bald ____ White
Race (select one): ____ (AI) Alaskan or American Indian ____ (AP) Asian or Pacific Islander ____ (BK) Black ____ (W) White
Ethnicity (select one): ____ (H) Hispanic Origin ____ (O) Not of Hispanic Origin ____ (U) Unknown
Place of birth: City:__________________________________ State: _____ County:___________________ Country:_______________________________________________________
Father’s Last Name:_________________________________________________________ Mother’s Maiden Name: ____________________________________________
CONTACT INFORMATION
Residence Address: _______________________________________________________________________________________________________________________
City:_______________________________________________________ State: _______ Zip Code:____________ County: _______________________________________
Mailing Address: __________________________________________________________________________________________________________________________
City:_______________________________________________________ State: _______ Zip Code:____________ County: _______________________________________
Home Phone:________________________ Other Phone:________________________ Email: _____________________________________________________________
In the event of injury or death would you like to provide up to two (2) emergency contacts? If yes, please list:
a) Name ____________________________________ Phone Number __________________ Address _________________________________________________________
b) Name ____________________________________ Phone Number __________________ Address _________________________________________________________
Alternate Address:
(Peace Officer or State / Federal Judge only)
Address: __________________________________________________________________________________________________________________________________
City:_______________________________________________________ State: _______ Zip Code:____________ County: _______________________________________
REQUIRED INFORMATION FROM ALL APPLICANTS
YES NO
1. ___ ___ Are you a citizen of the United States? If no, go to question 3.
2. ___ ___ If you are a U.S. citizen, would you like to register to vote? If registered, would you like to update your voter information?
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 fine 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 finally 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 final 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 office. Wanting to register to vote, I authorize the Department of
Public Safety to transfer this information to the Texas Secretary of State.
3. ___ ___ Are you a veteran? If no, go to question 4.
___ ___ a.) Are you a 60% disabled Veteran receiving compensation and want to waive the application fee? (Proof of disability required)
___ ___ b.) Do you want a Veteran designator on your DL or ID, or
___ ___ c.) 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?
(Proof of honorable discharge required; some acceptable documents are DD214/215, NGB22, VA disability letter, Veteran Identification card,
proof of service/verification of honorable service card. Proof of disability is required for Disabled Veteran designator)
___ ___ d.) If you want a Veteran or Disabled Veteran designator, do you want the branch of service shown on your DL or ID? If yes, select one:
_____ Army _____ Air Force _____ Coast Guard _____ Marines _____ Navy
4. ___ ___ Do you have a health condition that may impede communication with a peace officer? (Physician must complete form DL-101).
5. ___ ___ Would you like to register as an organ donor?
6. ___ ___ Do you want to donate $1.00 to the Blindness Education Screening and Treatment Program?
7. ___ ___ Do you want to support the Glenda Dawson Donate Life Texas donor registry? If yes, please indicate a donation amount of $1 or more
_________
8. ___ ___ Do you want to support Texas Veterans? If yes, please indicate a donation amount of $1 or more ___________
9. ___ ___ 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).
- -
