To be submitted by non-visa status individuals applying for a Temporary Visitor Driver’s License (TVDL).
FORM MUST BE COMPLETED IN ENGLISH.
You must complete this form and submit it to the Secretary of State’s office when you apply for a Temporary Visitor Driver’s License. In ad-
dition to this form, there are other documents you must bring. Please review the list of required documents at www.cyberdriveillinois.com.
To be eligible for a Temporary Visitor Driver’s License, a non-visa status individual must have lived in Illinois for at least one year. The in-
formation you provide on this form will be reviewed by Illinois Secretary of State employees to determine eligibility for the license.
Forms may be rejected if the information provided is incomplete.
In the next sections, you must provide information for each address you have lived in the last 12 months. Please pro-
vide complete and accurate information. If applicable, apartment or unit numbers must be included.
Your application may be denied if you do not include apartment numbers for multiple-unit addresses.
Please Check One: r Own/Buying r Renting r Other
If other, please specify:
Office of the Secretary of State
Driver Services Department
TVDL
2
701 S. DIRKSEN PARKWAY
SPRINGFIELD, IL 62723
www.cyberdriveillinois.com
Name:
Telephone Number:
Instructions:
Date of Birth:
Gender:
Email Address:
Current Address :
Street Address:
Apt./Unit#:
City:
Dates lived at
this address:
State:
ZIP Code:
County:
r M r F
From:
To:
Please Check One: r Owned r Rented r Other
If other, please specify:
Previous Address :
Street Address:
Apt./Unit#:
City:
Dates lived at
this address:
From:
To:
TVDL VERIFICATION OF RESIDENCY FORM
State:
ZIP Code:
County:
Please Check One: r Owned r Rented r Other
If other, please specify:
Previous Address :
Street Address:
Apt./Unit#:
City:
Dates lived at
this address:
From:
To:
State:
ZIP Code:
County:
Please Check One: r Owned r Rented r Other
If other, please specify:
Previous Address :
Street Address:
Apt./Unit#:
City:
Dates lived at
this address:
From:
To:
State:
ZIP Code:
County:
Submit additional copies of this form if necessary to provide residence information for the prior 12 months.
Under penalties of perjury, I swear or affirm that all information provided on this form is true and correct.
TVDL Applicant’s Signature: Date:
Printed by authority of the State of Illinois. October 2013 — 1 — DSD TVDL 8
