Central Services Division
555 Wright Way
Carson City, NV 89711
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Fax: (775) 684-4829
dmvnv.com
DLD-95 (Revised 9/2016)
Signatures must be originals. Photocopies are not acceptable.
Changes may not be made to this form once it is signed.
STATEMENT OF SURRENDER
OF
NEVADA DRIVER LICENSE AND VEHICLE REGISTRATION
(NRS 485)
Please print your Nevada driver license number and your Nevada license plate number in the spaces
provided below. The information is necessary to process this form.
Nevada Driver License No.:
Nevada License Plate No.:
I hereby certify that I have surrendered both my Nevada driver’s license and my Nevada
license plate to:
Nevada Department of Motor Vehicles
New State of residence:
Nevada law enforcement officer or agency
Other:
Reason for surrender:
I have never had a Nevada driver’s license or vehicle registration.
Current Address:
(Street address)
Area code
Telephone number
(City, State, Zip Code)
Print Name
Signature