DRIVERS LICENSE, DRIVER AUTHORIZATION CARD or IDENTIFICATION CARD APPLICATION

Information in boxes MUST be completed prior to visiting a DMV representative. Please PRINT in black or blue ink only.
Last Name First Name Middle Name


Suffix


Date of Birth Nevada DL/DAC/ID Number Social Security Number (not required for DAC)


Male Female Height ________ft. ________in. Weight ________lbs. Hair Color_________________ Eye Color _______________
Change to Information on Card: Name Date of Birth Social Security Number Address Gender
Daytime Phone Number (_____)______________________ E-mail Address _____________________________________________________

Full Legal Name on Birth Certificate__________________________________________________________________________________
Birthplace___________________________ State/Country ____________________ Mothers Maiden Name ________________________
Primary Physical Address __________________________________________________________________________________________
Street Apt. # City State Zip County
Mailing Address _________________________________________________________________________________________________
Street / P.O. Box Apt. # City State Zip County

If you are a U.S. citizen and already registered to vote in Nevada, this form will update your voter registration address information.
Did you move to a different county? Yes No If yes, you must also submit a NEW voter registration application.
I do or I do not want my address updated for voter registration purposes.

Please check boxes for all the vehicles you will drive (NAC 483.110)
GVWR = Gross Vehicle Weight Rating GCWR = Gross Combination Weight Rating
C


Any single vehicle less than 26,001 pounds GVWR or any such vehicle towing a vehicle not in excess of 10,000 pounds GVWR.
The holder of a Class C license may not drive a combination of vehicles exceeding 70 feet in length or have a combined weight
rating or a combined weight that exceeds 26,000 lbs. If the combination of the towing vehicle and the towed vehicle(s) exceeds
26,000 lbs., a Class A license is required.
B


Any single vehicle with a GVWR of 26,001 lbs. or more, or any such vehicle towing another vehicle which does not have a GVWR
of more than 10,000 lbs. (Holder of a Class B license may operate all Class C vehicles with the appropriate endorsement.)
A


Any combination of vehicles with a GCWR of 26,001 lbs. or more if the GVWR of the trailing vehicle is more than 10,000 pounds.
(Holders of a Class A license may operate all Class B and C vehicles with the appropriate endorsements.) A combination of
vehicles may not exceed 70 feet in length.
M


Motorcycle - May drive a motorcycle, trimobile or moped (NRS 486.041)
Moped (NRS 486.038 applies to mopeds only)

ENDORSEMENTS
J

In a Class C vehicle, you may tow a vehicle or combination of vehicles with a GVWR or GCWR, as appropriate, of more than 10,000 pounds.
The combination of vehicles may not exceed 70 feet in length or have a combined weight rating or a combined weight that exceeds 26,000 lbs.
If the combination of the towing vehicle and the towed vehicle(s) exceeds 26,000 lbs., a Class A license is required.
G

May operate an autonomous vehicle in autonomous mode. You must also complete a DP019 Autonomous Vehicle Endorsement application.
F


COMMERCIAL LICENSE EXEMPT FOR:

FIREFIGHTERS Operates emergency equipment
MILITARY Operates a commercial vehicle for military purposes
FARM Employees or family that transports supplies within 150 miles to
or from a farm, if not used:
As a common or contract motor carrier; or
To transport placarded amounts of hazardous materials
For Office Use Only
Documents Shown: Ind. ID # _________________________________________
DL/DAC/ID #:_______________________ Exp: __________
Test Required: Written Drive Reinstatement Info Restrictions: ___
PDPS/CLDIS Clear Hit State ________ DLN ______________ Vision Acuity: Left Both Right
W/D: _____ Cites: ______ 2
nd
Hit State ________ DLN ______________ With OR Without Correction: 20/ 20/ 20/
(Choose One)
Drivers License Instruction Permit
Identification Card Seasonal Resident ID Card
Driver Authorization Card (DAC) (Eff. 1/1/14)
Information Change (Select Option Below)


Voter Address
Change



ALL APPLICANTS MUST COMPLETE THIS SECTION Yes No
1. Have you ever had a drivers license or identification card in another name? (If yes, complete question 1a)...........................
(1a) Under what name was it issued? ____________________________
2. Have you ever had a drivers license or identification card in another state? (If yes, complete question 2a) ...........................
(2a) Do you have the card in your possession? ......................................................................................................................
State _________ License Number ____________________Class/Type __________ Expiration Date
NOTE: The drivers license or identification card application youre submitting will cause any driving record from your previous state to be
transferred to Nevada. Due to your change of residency, the license or identification card in your previous state will show as surrendered.
NRS 482.385 requires you to register each vehicle you own and operate now or within 30 days of becoming a resident. Initial:_________
3. Has your driving privilege ever been revoked, suspended, canceled or denied? .....................................................................
If yes, State _________________ Date _________________ Reason ________________________________________
4. Do you have any disabilities, illnesses, missing extremities, or take any medication that could affect your driving ability? ......
If yes, please explain
If you wish, some medical conditions may be indicated on your DL/DAC/ID. Form DLD7 must be completed by your physician.
5. Would you like to be an organ donor and have that information indicated on your license or identification card? ....................
NOTE: If you are at least 16 and under 18 years old, a parent or guardian may sign the affidavit below to ensure your wishes are followed.
6. Would you like to make a donation of $1 or more to the anatomical gift account? If yes, how much? ....
7. Would you like to register to vote or make changes to your current voter registration other than your address? .....................
If yes, complete a separate Voter Registration Application. Application Number: ___________________
8. Would you like to declare yourself an honorably discharged veteran of the Armed Forces of the United States? ....................
(Eff. 1/1/14) If so, your personal information will be electronically transmitted to the NV Office of Veterans Services.
(Eff. 1/1/14) If you are an honorably discharged U.S. veteran, would you like a veterans indicator placed on your license? ..
If so, please provide a copy of your DD-214, Discharge Papers & Separation Status.
9. If you are a male at least 18 years of age and less than 26 years old, would you like to register with the Selective Service? .
By registering, you will remain eligible for federal student loans, grants, benefits relating to job training, most federal jobs
and, if applicable, citizenship in the United States. If YES, please initial here:___________

DMV-002 (Revised: 8/13/13)
Affidavits and Signatures Must Be Witnessed by an
Authorized DMV Representative
Initial

________AFFIDAVIT CONSENT FOR MINORS LICENSE: I, the undersigned, do hereby consent to the issuance of an instruction
permit/license to _____________________________________, whose relationship to me is _______________________. I understand
that I can be held responsible for any liability caused by his/her negligence or willful misconduct in the operation of a motor vehicle (NRS
483.300 and/or NRS 486.101). I understand that I may have the permit/license cancelled and be released from liability by signing a
cancellation request at a DMV Field Services Office. I also understand that before a license is issued, the minor may need to present a
Certificate of Completion from a Nevada DMV-approved Driver Education Course and I need to sign and submit a DLD-130, Beginning
Driver Experience Log, to the DMV attesting that he/she has completed at least 50 hours of behind-the-wheel driving experience.

_______ AFFIDAVIT INSTRUCTION PERMIT: I, the undersigned, do hereby certify that I understand my instruction permit is valid for up
to one (1) year from date of issuance and I must carry it with me when I am driving. I understand the restrictions on my permit and agree to
follow them.

_______ AFFIDAVIT MINOR ORGAN DONOR: I, parent/guardian of minor applicant, understand that unless the anatomical gift is
amended or revoked by the donor before his/her death, I may not amend or revoke the anatomical gift._____________________________
Signature

_______AFFIDAVIT NON-USE OF NEVADA DRIVING PRIVILEGE: I, the undersigned, do hereby certify that I have not operated any
motor vehicle since (date) __________________________________.

_______AFFIDAVIT NO SOCIAL SECURITY NUMBER: I, the undersigned, do hereby certify that I have never been assigned a Social
Security Number under the provisions of the Social Security Act of the United States.

DISCLOSURE STATEMENT
The Privacy Act of 1974 is a federal law that authorizes use of your Social Security Number to verify identity. You are required to submit
your Social Security Number so that the state may administer laws related to licensing drivers (NRS 483.290).

I hereby certify, under penalty of perjury, that all statements in this application are true and correct. I understand that any and all
other drivers license or identification cards issued by any other jurisdiction will be surrendered upon issuance of a Nevada
license or identification card. I agree and understand that any misstatement of material facts may cause cancellation and/or
denial of my license or identification card under NRS 483.420 and NRS 483.530, respectively. I further understand that any
misstatement of facts may be a misdemeanor or felony under NRS 483.530 and may be punishable pursuant to NRS 193.130.

Applicant Signature Date
Parent/Guardian Signature if Applicant is Under 18 DL/DAC/ID No.
Sworn Before Me This Day of , 20
Authorized DMV Representative Tech ID
Signatures must be originals. Photocopies are not acceptable. Changes may not be made to this form once it is signed.