Liquor ID Card Application
Save time, go to mass.gov/RMV to apply online!
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A. Service Type
Service Type:
New
Renewal
Replacement
Change of Information (Enter new information in applicable fields):
Name
Address
DOB
Gender
Height
Eye Color
B. Applicant Information
Last Name First Name Middle Name Suffix
Date of Birth (MM/DD/YYYY) Current Massachusetts Learner’s Permit or Driver’s License # (if applicable) What is your Social Security Number?
Residential Address (Where you actually reside)
Street
Apt. #
City State Zip Code
Mailing Address
(same as above)
Street Apt. #
City
State Zip Code
Email Phone Type Phone #
Cell
Home
Work
Emergency Contact Information: (optional)
Email Name Phone Type Phone #
Cell
Home
Work
C. Required Demographic Information
Gender Eye Color Height (feet, inches)
M
F
Black
Brown
Gray
Hazel
Pink
Blue
Dichromatic
Green
Maroon
Unknown
Register me (or keep me registered) as an Organ and Tissue Donor: Yes No For more information on organ and tissue donation, visit: NEDS.org.
Would you like to donate $2 to the Organ and Tissue Donor Registration Fund? Yes No
(to be answered for renewal and replacement transactions only)
Military Status (documentation is required if checked visit mass.gov/rmv for acceptable documents)
Are you an active duty member?
What military branch?
If you are a veteran of the U.S. Armed Forces, do you
want the word “VETERAN” printed on your ID?
D. Certification and Signature of Applicant (application not complete without signature)
I have reviewed this completed Application Form, including the Voter Registration Section, and hereby apply for a Liquor ID card and swear
(affirm), under the penalties of perjury, that the information I have provided is true and correct.
I am aware that false statements are punishable by fine, imprisonment, or both under M.G.L. Chapter 90, Section 24B.
Signature: __________________________________________________________ Date: __________________________
The Registrar reserves the right to cancel, revoke, or recall, any permit, license, or ID card if it is determined that the applicant was not qualified for
such permit, license, or ID card.
Complete the required Voter Registration section on back of form.
RMV Use Only
Date: ________________________ Clerk Initials: ___________
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E. Voter Registration
To vote in Massachusetts you must be: A U.S. CITIZEN, a resident of Massachusetts and at least 18 years old on or before the next election in your city
or town, which could be a town meeting, city or town preliminary, city or town election, state primary, state election, special state primary, special state
election, or special city or town election.
1. Do you want to register to vote? .........................................................................................................................................................
Yes
No
Check “Yes” if you want to register to vote, or you are changing your name or address and want to be registered to vote with this new information.
If you answered “yes,” complete question #2 and read the Affirmation Section below.
Check “No” if you are currently registered to vote and do not want to change your voter registration.
2. Are you a citizen of the United States of America? .............................................................................................................................
Yes
No
NOTE: If you answered “no” to this question, do not complete question #3. You are not eligible to register to vote at this time.
3. Please indicate party enrollment or political designation (check one).
Democratic
Republican
Libertarian
Green-Rainbow
No Party (unenrolled)
Political Designation (not a political party) (Print desired designation): ______________________________________
PLEASE ASK THE LICENSE CLERK FOR YOUR VOTER REGISTRATION RECEIPT
AFFIRMATION TO BE READ BY APPLICANTS REGISTERING TO VOTE
I hereby swear (affirm) that I am the person named above, that the above information is true, that I AM A CITIZEN OF THE UNITED STATES, that I
am at least 16 years old and I understand that I must be 18 years old to be eligible to vote, that I am not a person under a guardianship which prohibits
my registering to vote, that I am not temporarily or permanently disqualified by law from voting because of corrupt practices in respect to elections, that I
am not currently incarcerated for a felony conviction, and that I consider this residence to be my home. Signed under the penalty of perjury.
Confidentiality of voter registration information: If you register to vote, the office at which you submit your application will remain confidential and will
be used only for voter registration purposes. If you decline to register to vote, the fact that you declined to register will remain confidential and will be
used only for voter registration purposes.
Penalty for illegal voter registration: Fine of not more than $10,000 or imprisonment for not more than five years or both (M.G.L., Chap. 56, Section 8).