Printed by authority of the State of Illinois. August 2019 – 1 – DSD A 329
I (print name from above), ______________________________________________________________________________________
wish the gender designation on my driver’s license/ID card to read: n Male n Female
Attestation
I hereby swear, under the penalty of perjury, that this request for the selected gender designation to appear on my driver’s
license/ID card is for the purpose of ensuring that my driver’s license/ID card accurately reflects my gender identity and is not
for any fraudulent or other unlawful purpose.
Signature: _______________________________________________________________ Date: _____________________________
False statements are punishable by fine, imprisonment, or both.
A. Applicant Information (Name on current driver’s license/ID card)
Last Name First Name Middle Name Suffix
Driver’s License/ID Card Number
Residential Address
Street Apt. # City State ZIP
B. Gender Designation Statement
Gender Designation Change Form
Office of the Secretary of State
Driver Services Department
2701 S. DIRKSEN PKWY.
SPRINGFIELD, IL 62723
800-252-8980
www.cyberdriveillinois.com
The Secretary of State (SOS) can only accept original forms with original signatures.
Photocopies and faxes are not acceptable.
You must surrender the existing driver’s license or ID card that is to be changed.
To Be Completed by SOS Personnel Only
Employee ID #: __________________________________________________________________ Date: ________________________
Employee Signature: ______________________________________________________________________________________
