Kansas Driver's License Extension or Replacement Form
FOR USE ONLY BY NON-MILITARY PERSONS AGE 21 OR OLDER RESIDING OUT OF STATE OR COUNTRY
PLEASE PRINT LEGIBLY
This form is only for use by Non-Military person age 21 or older that are residing out of state or country.
If you are Military or Military dependent age 21 or older, residing out of state or country,
visit www.ksrevenue.org/dmvoutofstate.htm to locate the correct procedures pertaining to your situation.
Please complete the following information and answer all 8 questions
What are you applying for? (check one)
Replacement Extension
Current Driver's
license number
Social Security
Number
Date of
Birth
Please note - We are required by law to obtain and record your SSN on our records, however it will not be displayed on your driver's license. If your
driver's license number is currently your SSN it will be changed to a system generated number.
Last Name First Name
Mailing Address - Out of state or out of country address where the license will be mailed
Street City State Zip
Residence Address - Must be a Kansas address
Street City State Zip
1 Is your license now or has it ever been suspended/revoked in Kansas or any other state? Yes No
If so, where? Why?
2 Do you currently have any physical or mental disabilities that could make it difficult to operate a motor vehicle safely? Yes No
If so, what are they?
3 Have you suffered a seizure in the last 6 months? Yes No What was the cause?
4 Are you currently a habitual user of alcohol or drugs? Yes No
5 Do you have a pending suspension/restriction/revocation in Kansas or any other state? Yes No If so, where?
6 Are you a resident of the state of Kansas? Yes No
7 Are you lawfully present in the United States? Yes No
8 Do you understand that your answers to these questions, if answered falsely, may be grounds for prosecution? Yes No
Renewal Instructions
Only Military and Military dependents are allowed to renew their Kansas driver's license through the mail. You may be eligible to apply
for a 6 month e
xtension.
Replacement Instructions
Applicant must submit photocopies of 2 forms of ID (see www.ksrevenue.org/dmvproofmailin.htm) along with this form and $1
6 fee. All
documents mailed in will be retained in our office and will not be returned to you. Do Not send original documents.
Extension Instructions
One six month extension can be granted to anyone that is out of state or country when their license expires. Complete this form and mail
it in with a copy of your Kansas driver's license. There is no fee for an extension.
Payment and Mailing Information
Fees may be paid by money order, check or major credit card. Do not send cash. Make check or MO payable to Kansas DMV. Mail all
necessary forms and fees to: DMV, PO Box 2188, Topeka, KS 66601-2188.
Faxes are not accepted.
A 2.5% convenience fee will be added to all credit card transactions
Visa MC AmExpress Discover (circle one) Card Number
Exp. Date Signature
Date
Daytime Phone #
Email Address
Please sign your signature in this box in black ink
If you are a male between the ages of 16 and 26, your information will be forwarded to the Selective Service System
For more information go to www.ksrevenue.org/selserv.htm
DEMI-2 (08/2010)
