TRAVEL LICENSE / IDENTIFICATION APPLICATION
What are you applying for?
Driver License
Identification Card
Commercial License
Permit (Not For Federal Identification) CDL Permit (Not For Federal Identification) Motorcycle
Have you ever had a DL/ID
issued in Arizona? Yes
Contact Number (optional)
( )
Applicant Name (First, Middle, Last)
Mailing Address (if different from above)
Appear on license
Female
Date of Birth (Month/Day/Year)
Voter Registration: Do you want to register to vote or update your voter registration and do you meet all the following eligibility requirements? (1) I am a
U.S. citizen
; (2) I am an Arizona resident; (3) I will be at least 18 years old by the next general election; (4) I have NOT been convicted of a felony
ivil rights restored); and (5) I have NOT been found mentally incapacitated with my voting rights revoked.
To vote in the next election, you must register at least 29 days before the election. The place where you register, or your d
ecision not to register
, will be
kept confidential. Submitting a false voter registration is a class 6 felony.
YES, register me to vote or update my registration. By signing below, I swear or affirm that I meet all eligibility requirements listed above.
I want to be placed on the Permanent Early Voting List (PEVL) and receive an early ballot by mail for each election I am eligible for.
NO, do not use this information for voter registration.
. DONOR♥ I check this box to become an organ/tissue donor and join the DonateLifeAZ Registry. DONOR♥ will print on my license.
. I am a U.S. Military veteran who was enlisted, drafted, inducted or commissioned to serve in the active military, naval, or air servi
dishonorably discharged. I would like the word “VETERAN” printed on my license/ID. (Proof Required)
. I have a medical condition that I want displayed on my license/ID. (Proof Required)
. Do you have a physical, psychological or visual condition (other than wearing corrective lenses), or alcohol/drug dependency or
are you currently
taking any medications that could affect your ability to safely operate a motor vehicle?
. Have you ever been determined to be incapacitated by a court? YES
. (Optional) Do you consent to the release of personal information contained in your driver license and vehicle record? I understand that this is not a one
time consent that applies only to a specific individual or organization,
but is instead a general consent that applies to all requests from any and all
individuals or organizations for any purpose, until revoked by me in writing. (Consent for a vehicle record applies to all owners) YES
States where you held any type of license in the last 10 years (CFR) 49 Section 384.206
Non-Excepted Interstate: I certify that I operate, or expect to operate, in interstate commerce and that I meet the qualifications under 49 CFR 391. I
understand that I am required to
obtain a medical examiner’s certificate according to 49 CFR 391.45.
Non-Excepted Intrastate: I certify that I operate in intrastate commerce and therefore am subject to Arizona driver qualifications. I understand that I am
required to obtain a medical examiner’s certificate according to 49 CFR 391.45.
I do not want a Travel DL/ID (Federal REAL ID Act compliant credential).
I understand that by checking this box, my license or ID will state
NOT FOR FEDERAL IDENTIFICATION across the top and cannot be used at airport security or to enter federal buildings, military bases or nuclear power
plants and might not be usable for other purposes.
All Applicants
: I certify under penalty of perjury that the information above is true and correct. I understand that
I must report a change of address or
name to MVD within 10 days.
All Driver Applicants:
I understand the laws, rules and regulations described in the Arizona Driver License Manual, and that
I must report to MVD in writing, within 10 days, any medical condition that develops or worsens that may affect my ability to safely operate a motor
vehicle.
You are required by A.R.S. §§ 28-3158(D)(4) and §§ 28-3165(F), under authority of 42 U.S.C. §§ 405(c)(2)(C) and
666 (a)(13)(A), to provi
de your Social Security Number. It will be used to verify your identity and to comply with federal and state child support
enforcement laws. It will not be used as your driver license or identification card number.
Male Applicants Under 26
: By submitting this application, I consent to registration with the Selective Service System if I am required to register unde
r
federal law. If I am under 18, I understand that I will be registered as required by federal law when I become 18.
Acknowledged before me this date.
Notary or MVD Agent Signature & RACF
