DSMV637 (Revised 1/20)
I wish to have my social security number removed from DMV Records, pursuant to RSA 263:40-a.
I do not wish to have my photograph retained in the records of the Department of Safety. (RSA 260:14).
I wish to have my legal address appear on the back of my driver license or I.D. card.
I am 18 years old and consent to registration with the Selective Service System as required by Federal Law. (RSA263:5-c).
Make checks payable to: State of NH - DMV
Payment Method:
CASH CHECK CREDIT CARD MONEY ORDER
PLEASE PRINT CLEARLY IN BLUE OR BLACK INK
I AM APPLYING FOR
Duplicate Driver License Duplicate Non – Driver ID Card
IDENTIFICATION INFORMATION
PLEASE CHECK BOX IF MAILING AND LEGAL ADDRESS ARE THE SAME
FIRST NAME (REQUIRED) MIDDLE (REQUIRED) LAST NAME (REQUIRED) SUFFIX (Sr, Jr, etc.)
ADDRESS WHERE YOU GET YOUR MAIL (REQUIRED)
ADDRESS WHERE YOU LIVE (REQUIRED)
(ALL ARE REQUIRED)
DATE OF BIRTH GENDER HEIGHT
WEIGHT
EYE COLOR
HAIR COLOR
POUNDS
SOCIAL SECURITY INFORMATION TELEPHONE NUMBER (OPTIONAL) E-MAIL ADDRESS (OPTIONAL)
( ) -
OPTIONAL (CHECK ANY THAT APPLY)
I wish to add the Veteran Indicator
(Additional documents required)
I wish to have my social security
number removed from DMV
Records, pursuant to RSA 263:40-a
(Does not apply to REAL ID)
I do not wish to have my photo-
graph retained in the records
of the Department of Safety
(RSA 260:14)
(Does not apply to REAL ID)
I wish to have my legal address appear on the back of
my driver license or ID card. (Required on REAL ID)
I am 18 years old and consent to registration with the Selective
Service System as required by Federal Law (RSA 263:5-c)
(Only for males age 18 – 25)
By signing above, I certify that I have paid all resident taxes or Interest and Dividends Tax (RSA 77) for which I am liable, and,
if required, insurance certificates are on file with the Director of Motor Vehicles. My driving privileges are not subject to or under
disqualification, suspension or revocation by any jurisdiction (does not apply to non-driver ID).This application is signed under
penalty of unsworn falsification pursuant to RSA 641:3.
CHECK HERE TO
SAVE A LIFE
By checking this box, you consent to Organ & Tissue Donation pursuant to RSA 263:41. Donation information
will be provided to federally-designated organizations so that your decision to donate may be honored.
Vision Test With CL Without CL
LICENSE TYPE
Duplicate Driver License
Duplicate Non-Driver Identification
$10.00
$10.00
Reason needed for duplicate: __________________________________________________________________
FEET INCHES
FEMALE OTHER
State of New Hampshire Department of
Safety
Division of Motor
Vehicles
APPLICATION FOR A DUPLICATE DRIVER LICENSE OR NON-DRIVER ID
CARD
