APPLICATION FOR DRIVING PRIVILEGES OR ID CARD
ORIGINAL
RENEWAL DUPLICATE ADDRESS CHANGE INSTRUCTION PERMIT
Information in boxes MUST be completed prior to visiting a DMV representative. Please PRINT in black or blue ink only.
DMV-002E Revised 6/2019
OFFICE USE ONLY
Individual ID #:
Drive
Written:
Vision Acuity Correction
With OR Without
LEFT BOTH RIGHT
20/___ 20/___ 20/___
Reinstatement Info: ___________________________
Restrictions: _________________________________
PDPS/CDLIS: CLEAR HIT W/D:________________ CITES: _________ 2
nd
HIT
State:________________ DLN:____________________
Docs/Notes: ___________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
LICENSE OR PERMIT
Real ID Standard
Driver Authorization Card
ENDORSEMENTS
J F
IDENTIFICATION CARD
Real ID Standard
Seasonal Resident
LAST NAME (PRINT)
FIRST NAME
MIDDLE NAME
SUFFIX
NEVADA DL/DAC/ID NUMBER
SOCIAL SECURITY NUMBER (Except DAC)
DATE OF BIRTH
FULL LEGAL NAME ON BIRTH CERTIFICATE
BIRTHPLACE (CITY/STATE OR COUNTRY)
SEX (CIRCLE ONE)
M F X
HEIGHT
FT. IN.
WEIGHT
LBS.
HAIR COLOR
EYE COLOR
MOTHERS MAIDEN NAME
Do not scan my Birth Certificate
YES, print my mailing address on the front of my card (Except Real ID)
PRIMARY PHYSICAL ADDRESS (PRINCIPAL RESIDENCE)
MAILING ADDRESS (IF DIFFERENT FROM PHYSICAL ADDRESS)
CITY, STATE, ZIP CODE
CITY, STATE, ZIP CODE
DAYTIME PHONE NUMBER (OPTIONAL)
( )
EMAIL ADDRESS (OPTIONAL)
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
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
ORGAN
DONOR
Would you like to be an organ donor and have that indicated on your license or identification card?
Would you like to donate $1 or more to the anatomical gift account? If so, how much $ ___________
YES, I wish to be
an organ donor
NO, I do not wish
to be an organ donor
DRIVING
HISTORY
Have you ever had a driver’s license or identification card in another name?
If yes, under what name was it issued?
YES NO
Have you ever had a driver’s license or identification card in another state?
If yes, list all States you have ever had a driver’s license or identification card: ______________________
License #: Class/Type:
Expiration
Date:
YES NO
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-002E Revised 6/2019
STOP
Affidavits and Signatures Must Be Witnessed by an Authorized DMV Representative
I hereby certify, under penalty of perjury, that all statements in this application are true and correct. I understand that any and all other
driver’s licenses or identification cards issued by any other jurisdiction will be surrendered upon issuance of a Nevada license or
identification card. I agree and understand that any misstatement of material facts may cause cancellation and/or denial of my license
or identification card under NRS 483.420 and NRS 483.530, respectively. I further understand that 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 _________________________
Parent/Guardian Signature if Applicant is under 18 _________________________________________ DL/ID________________________
Sworn before me this ___________________ Day of _______________________________________________20___________________
Authorized DMV Representative/Notary Public ______________________________________________________________________
Signatures must be originals. Photocopies are not acceptable. Changes may not be made to this form once signed.
VOTER
REGISTRATION
Unless you decline in writing, federal and state laws require this DMV transaction to serve as an application to register to vote
or update existing voter registration information and authorizes the transmission of information to the applicable election
officials. You may decline to use this transaction for voter registration on a form provided at the end of this transaction.
A voter registration record must indicate a major political party in order to vote for candidates in a primary election. You may
indicate your political party on the form provided at the end of this transaction.
Note: A new voter registration record will default to “nonpartisan” (no political party) unless a political party is indicated on the
form provided at the end of this transaction.
Your decision to apply, update or decline to use this transaction for voter registration will not affect the assistance or services
provided. Both the source of your information and decision to apply, update or decline to register to vote will remain
confidential and will only be used for voter registration purposes.
Voter registration may impact the following groups:
Uniformed Service Members should note changes to home of record for voting, and impacts on residency and/or tax status.
Confidential Voters might need to take additional action to prevent disclosure of public information.
Voting Rights are immediately restored for all felony convictions upon release from prison.
Are you a citizen of the United States of America?
YES NO
Will you be 18 years or over on or before Election Day? YES NO → If No, are you 17 and would like to preregister?
YES NO
If applicable, check one of the following:
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.)
CONSENT FOR MINOR’S LICENSE: I consent to the issuance of an instruction permit/license to ,
whose relationship to me is . I understand I can be held responsible for any liability caused by
his/her negligence or willful misconduct in the operation of a motor vehicle (NRS 483.300 and/or NRS 486.101). I understand I
may have the permit/license cancelled & be released from liability by signing a cancellation request. I understand, before a
license is issued, he/she may need to present a DMV-301 Certification of Attendance, a Certificate of Completion from a Nevada
DMV-approved Driver Education Course, & a DLD-130 Beginning Driver Experience Log attesting he/she has completed at least
50 hours of behind-the-wheel driving experience.
INSTRUCTION PERMIT: I certify that I understand my instruction permit is valid for up to one (1) year from
date of issuance and I must carry it with me when I am driving. I understand the restrictions of my permit
and agree to follow them.
Initial
MINOR ORGAN DONOR: I, parent/guardian of minor applicant, understand unless the anatomical gift is
amended or revoked by the donor before his/her death, I may not amend or revoke the anatomical gift.
Parent/Guardian Signature
NON-USE OF NEVADA DRIVING PRIVILEGE: I have not operated a motor vehicle since: _________Date
Initial
NO SOCIAL SECURITY NUMBER: I certify I have never been assigned a Social Security Number under
the provisions of the Social Security Act of the United States.
Initial
DISCLOSURE STATEMENTS:
*The Privacy Act of 1974 is a federal law authorizing the use of your Social Security Number to verify identity. You are required
to submit your Social Security Number so the State may administer laws related to licensing drivers (NRS 483.290).
The driver’s license or identification card application you are submitting will cause any driving record from your previous State to
be transferred to Nevada and will show as surrendered. NRS 482.385 requires you to register each vehicle you own and operate
within 30 days of becoming a resident.
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