DL-31 (12-10)
NON-COMMERCIAL LEARNER'S PERMIT
APPLICATION TO ADD/EXTEND/ REPLACE/CHANGE/CORRECT
DEPARTMENT OF TRANSPORTATION
Bureau of Driver Licensing P.O. Box 68272 Harrisburg, PA 17106-8272
If you have not taken or successfully completed the Road Test within three (3) years of your physical examination date, you MUST start over with another Non-Commercial Learner's Permit Application and retake the Knowledge Test.
NOTE: TYPE OR PRINT IN BLUE OR BLACK INK ALL INFORMATION AS IT APPEARS ON YOUR CURRENT PENNSYLVANIA NON-COMMERCIAL DRIVER'S LICENSE OR LEARNER'S PERMIT
DRIVER'S LICENSE NUMBER
LAST NAME
JR/ETC
FIRST NAME
MIDDLE NAME
DATE OF BIRTH Month Day Year
TELEPHONE NUMBER (8:00 A.M.-4:30 P.M.)
E-MAIL ADDRESS (if applicable)
CHECK APPLICABLE BLOCK ON LINE 1 AND 2:
1. 2.
ADD/EXTEND CLASS C
LOST (Replace) CLASS B
STOLEN (Replace) CLASS A
MUTILATED (Replace)
NEVER RECEIVED (Complete Section D)
CHANGE OR CORRECTION ONLY (Important information on reverse side) ADDRESS CHANGE - A Post Office Box number may be used in addition to the actual residence address, but cannot be used as the only address.
See reverse if using an out-of-state address.
NEW STREET ADDRESS CITY STATE
PA
ZIP CODE
If you are a registered voter in PA, would you like us to notify your county voter registration office of this change? If you are not a registered voter, you may contact your county voter registration office.
YES
NO
NAME CHANGE
LAST NAME
REASON:
MARRIAGE
DIVORCE
OTHER (see reverse side)
JR., ETC. FIRST NAME MIDDLE NAME
OTHER CHANGES
EYE COLOR (Please check one): BLUE BROWN GREEN HEIGHT
YEAR FEET INCHES
HAZEL
PINK
BLACK
GRAY
DICHROMATIC
OTHER _______________
CORRECTION OF DATE OF BIRTH
MONTH DAY
SOCIAL SECURITY NUMBER
AUTHORIZATION AND CERTIFICATION
I certify under penalty of law that all information given on this application is true and correct. I hereby authorize the Social Security Administration to release to the Department of Transportation information concerning my Social Security Identification Number for the purpose of identification. If using a Messenger Service, I hereby authorize the Department to furnish them with my driving record for the purpose of processing this form. I hereby acknowledge this day that I have received notice of the provisions of Section 3709 of the Vehicle Code. (See reverse for provisions.)
SIGN HERE
APPLICANT'S SIGNATURE IN INK DATE
WARNING: Misstatement of Fact is a misdemeanor of the third degree punishable by a fine of up to $2,500 and/or imprisonment up to 1 year (18 PA. C.S. Section 4904(b)).
Send check in this amount
FEE PAID
(See Reverse Side for Fees)
I hereby certify that I am
NOTARY MUST BE COMPLETED IF PRODUCT NOT RECEIVED OR IF APPLICANT IS UNDER THE AGE OF 18
MUST BE COMPLETED IF APPLICANT IS UNDER THE AGE OF 18
If you never received your Learner's Permit you are entitled to a free permit ONLY if this application is completed within 90 days of the original date of issuance and the original was never received due to loss in the mail.
SUBSCRIBED AND SWORN TO BEFORE ME: MO. DAY YEAR
Parent, Guardian, Person in Loco Parentis, or Spouse at least 18 years of age, of the applicant named herein, that the statements made hereon are true and correct to the best of my knowledge and that this application is made with my full consent.
SIGN HERE
SIGNATURE OF PERSON ADMINISTERING OATH
S E A L
SIGN IN PRESENCE OF NOTARY
(Signature of Parent, Guardian, Person in Loco Parentis or Spouse at least 18 years of age)
(Print Name as it Appears in Signature Above)
DL-31 (12-10)
The most current version of this form can be found at: www.dmv.state.pa.us
INSTRUCTIONS 1. OUT-OF-STATE ADDRESS CHANGE. We may not issue driver license products to an out-of-state address, except in the case of an employee of federal or state government, armed forces personnel, or their families, whose workplace is located outside of Pennsylvania. If this exception applies to you, please check the appropriate box and include documentation of your status with this application. Attach a letter from your employer on their letterhead to document your status, or attach a copy of your current Photo ID issued by your employer. If you are the immediate family of a person meeting one of the allowable exceptions, attach the documentation of the person employed. Additionally, you must indicate your relationship to that person. I certify that my workplace is located out-of-state and I am employed by, or am the immediate family of a person employed by: US Armed Forces Federal Government Pennsylvania State Government Spouse Dependent Child Relationship to person meeting exemption (check one):
2. All applicants must complete Sections A, B (if applicable), and C. 3. Notarization (Section D) is required IF (1) applying for a never received Learner's Permit or (2) applicant is under the age of 18. 4. Section E MUST be completed if applicant is under the age of 18. FEE INFORMATION 1. The fee for a non-commercial Class A, B, or C Learner's Permit is $5.00 for each permit requested. If you checked the never received block and Section D is notarized, a fee is not required. 2. Please make your check or money order payable to PennDOT. 3. Please mail the application and required fee to; Bureau of Driver Licensing, P.O. Box 68272, Harrisburg, PA 17106-8272. CLASS INFORMATION (Minimum Age 16) Required to operate a single non-commercial* vehicle not over 26,001 lbs. gross vehicle weight rating (such as passenger car, station wagon, or small truck) or any such vehicle, except those requiring a motorcycle classification, that does not meet the definition of Class A or Class B. (Class C permit does not include any other class.) (Minimum Age 18) Required to operate a combination non-commercial* vehicle with a gross vehicle weight rating of 26,001 pounds or more, provided the gross vehicle rating of the vehicle being towed is in excess of 10,000 pounds. (Class A permit includes Classes B and C.) (Minimum Age 18) Required to operate a non-commercial* single vehicle of 26,001 pounds or more gross vehicle weight rating or any such vehicle towing a trailer not over 10,000 pounds gross weight. (Class B permit includes Class C.)
CLASS C
CLASS A
CLASS B
The holder of a Class A, B, or C driver's license will also be authorized to drive a moped. *The term includes an implement of husbandry, certain motorized construction equipment not intended for on-road use, or any motor home or recreational trailer operated solely for personal use. CHANGE/CORRECTION ONLY
1. Name Change - If your name changed by permission of court, attach a Certified Copy of the Court Order. If you desire to use a name other than your (1) birth name, (2) spouse's surname, or (3) a name given through a Court Order, you must provide a copy of your Social Security Card (or records), together with copies of documents from two other sources issued in the desired name such as: Tax Records, Selective Service Card, Voter Registration Card, Passport, any form of Photo I.D. issued by a governmental agency, or state issued Birth Certificate. IF YOUR LEARNER'S PERMIT contains an error, please return it with this form showing the correct information and it will be replaced. IF YEAR OF BIRTH on Learner's Permit is incorrect, attach official birth certificate. IF SOCIAL SECURITY NUMBER is incorrect, attach a copy of Social Security Card. Change your address or renew your driver's license online at www.dmv.state.pa.us PROVISIONS OF SECTION 3709 OF THE VEHICLE CODE Section 3709 provides for a fine of up to $300 for dropping, throwing or depositing, upon any highway, or upon any other public or private property without the consent of the owner thereof or into or on the waters of this Commonwealth, from a vehicle, any waste paper, sweepings, ashes, household waste, glass, metal, refuse or rubbish or any dangerous or detrimental substance, or permitting any of the preceding without immediately removing such items or causing their removal. For any violation of Section 3709, I may be subject to a fine of up to $300 upon conviction, including any violation resulting from the conduct of any other persons present within any vehicle of which I am the driver.
