APPLICATION FOR DRIVING PRIVILEGES OR ID CARD
ORIGINAL
RENEWAL DUPLICATE ADDRESS CHANGE INSTRUCTION PERMIT CHANGE
Information in boxes MUST be completed prior to visiting a DMV representative. Please PRINT in black or blue ink only.
DMV-002E Revised 6/2021
LICENSE OR PERMIT
Real ID
Standard
Driver Authorization Card
CLASSIFICATION
Class C Class A
Class M Class B
ENDORSEMENTS
J F
IDENTIFICATION CARD
Real ID Standard
Seasonal Resident
LAST NAME (PRINT)
FIRST NAME
MIDDLE NAME
SUFFIX
NEVADA DL/DAC/ID NUMBER
SOCIAL SECURITY NUMBER (Except DAC)
DATE OF BIRTH
FULL LEGAL NAME ON BIRTH CERTIFICATE
BIRTHPLACE (STATE AND COUNTRY)
SEX (CIRCLE 1)
M F X
HEIGHT
FT. IN.
WEIGHT
LBS.
HAIR COLOR
EYE COLOR
MOTHER’S MAIDEN NAME
Do not scan my Birth Certificate
YES, print my mailing address on the front of my card (Except Real ID)
PRIMARY PHYSICAL ADDRESS (PRINCIPAL RESIDENCE)
MAILING ADDRESS (IF DIFFERENT FROM PHYSICAL ADDRESS)
CITY, STATE, ZIP CODE
CITY, STATE, ZIP CODE
DAYTIME PHONE NUMBER (OPTIONAL)
( )
EMAIL ADDRESS (OPTIONAL)
CITIZEN
Are you a United States citizen?
YES NO
VOTER
REGISTRATION
Are you 18 years or older?
YES NO
Are you currently 17 and would like to preregister? You will be able to vote when you turn 18.
YES NO
If you are eligible, you will be registered to vote or have your voter registration updated. If you want to choose a
political party or opt-out of registering to vote, we will give you a form at the end of your transaction today. Unless you opt-
out, we will send your information to your County Clerk/Registrar. If you had a felony conviction, you are eligible to vote on
release from prison. Your choice to register to vote or not and the place where you register are confidential and will not affect
the assistance or services provided to you by the DMV. Nevada Revised Statute Chapter 293.
Uniformed and Overseas Citizens Absentee Voting Act (UOCAVA). If applicable, check one of the following:
Domestic Military (or military spouse or dependent) on active duty and absent from Nevada voting residence
Overseas Military (or military spouse or dependent) on active duty and absent from Nevada voting residence
Overseas Citizen residing outside the U.S. (not applicable to those traveling/vacationing outside the U.S.)
ORGAN
DONOR
Would you like to be an organ donor and have that indicated on your license or identification card?
YES NO
If you would you like to donate $1 or more to the anatomical gift account, indicate how much here: $______________
DRIVING
HISTORY
Have you ever had a driver’s license or identification card in another name?
If yes, under what name was it issued?
YES NO
Have you ever had a driver’s license or identification card in another state?
If yes, list all states you have ever had a driver’s license or identification card: _____________________
License #: Class/Type:
Expiration
Date:
YES NO
Has your driving privilege ever been revoked, suspended, canceled or denied?
If yes, from which state(s): Date: Reason:
YES NO
MEDICAL
HISTORY
Do you have a disability or missing extremity?
YES NO
YES NO
Do you have any illness or take any medication that could affect your driving ability?
YES NO
If you answered YES to either question, please explain:
NOTE: Some medical conditions may be indicated on your DL/DAC/ID. Form DLD7 must be completed by a physician.
OFFICE USE ONLY
Individual ID #:
Drive
Written:
Vision Acuity Correction
With OR Without
LEFT BOTH RIGHT
20/___ 20/___ 20/___
Reinstatement Info: ___________________________
Restrictions: _________________________________
PDPS/CDLIS: CLEAR HIT W/D:________________ CITES: _________ 2
nd
HIT
State:________________ DLN:____________________
Docs/Notes: ___________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
TURN OVER
DMV-002E Revised 6/2021
SELECTIVE
SERVICE
If you were born male and are 18-26 yrs old, you will be registered for Selective Service. If you are
eligible but choose NO, you will no longer be eligible for federal student loans, grants, benefits relating
to job training, most federal jobs and, if applicable, U.S citizenship.
NO, I am not
eligible or do not
wish to register
VETERAN
1
I have a U.S. Armed Forces honorable discharge and wish to have a veteran designation placed/retained
on my license. If your card does not already have a veteran designation, you must present proof of
honorable discharge.
YES NO
2
Have you ever served on active duty in the Armed Forces of the United States and separated from such
service under conditions other than dishonorable?
YES NO
3
Have you ever been assigned to duty for a minimum of 6 continuous years in the National Guard or a
reserve component of the Armed Forces of the United States and separated from such service under
conditions other than dishonorable?
YES NO
4
Have you ever served the Commissioned Corps of the United States Public Health Service or the
Commissioned Corps of the National Oceanic and Atmospheric Administration of the United States in the
capacity of a commissioned officer while on active duty in defense of the United States and separated
from such service under conditions other than dishonorable?
YES NO
STOP
You will fill this out with the DMV Representative so they can witness your signature
CONSENT FOR MINOR’S LICENSE: I consent to the issuance of an instruction permit/license to , whose
relationship to me is . I understand 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 I may have the
permit/license cancelled & be released from liability by signing a cancellation request. I understand, before a license is issued, he/she may
need to present a DMV-301 Certification of Attendance, a Certificate of Completion from a Nevada DMV-approved Driver Education
Course, & a DLD-130 Beginning Driver Experience Log attesting he/she has completed at least 50 hours of behind-the-wheel driving
experience.
Initial _____________
INSTRUCTION PERMIT: I 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 of my permit and agree to
follow them.
Initial
MINOR ORGAN DONOR: I, parent/guardian of minor applicant, understand unless the anatomical gift is amended
or revoked by the donor before his/her death, I may not amend or revoke the anatomical gift.
Parent/Guardian Signature
NON-USE OF NEVADA DRIVING PRIVILEGE: I have not operated a motor vehicle since: _______Date
Initial
NO SOCIAL SECURITY NUMBER: I certify I have never been assigned a Social Security Number under the
provisions of the Social Security Act of the United States.
Initial
DISCLOSURE STATEMENTS:
*The Privacy Act of 1974 is a federal law authorizing the use of your Social Security Number to verify identity. You are
required to submit your Social Security Number so the state may administer laws related to licensing drivers (NRS 483.290).
The driver’s license or identification card application you are submitting will cause any driving record from your previous state
to be transferred to Nevada and will show as surrendered. NRS 482.385 requires you to register each vehicle you own and
operate within 30 days of becoming a resident.
I hereby certify, under penalty of perjury, that all statements in this application are true and correct. I understand that any and all
other driver’s licenses 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/ID_______________________
Sworn before me this ___________________ Day of ___________________________________________20____________________
Authorized DMV Representative/Notary Public ______________________________________________________________________
Signatures must be originals. Photocopies are not acceptable. Changes may not be made to this form once signed.
