Form Mvd-10231 - Driver License Surrender Form

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MVD–10231
New Mexico Taxation & Revenue Department, Motor Vehicle Division
REV. 08/09
DRIVER LICENSE SURRENDER FORM
Applicant and Current License Information
Applicant last name
First name
Middle name
Last four digits of Social Security Number (xxxx)
Date of birth (mm/dd/yyyy)
Current (surrendered) driver’s license number
State of issue
Please check below all boxes that apply to the current transaction.
I am applying for a ❑ Driver License or ❑ CDL License in the State of New Mexico. My Driver Record in
the state of ________________________________ indicates that I have a valid license in that state.
I am applying for an Identification Card (ID) in the State of New Mexico. By doing so I understand
that I am surrendering my commercial driver’s license (CDL) and driving privileges. I understand that
I will have to take the written tests, eye test and skills tests and pay all fees associated with a new
Commercial Driver’s License in order to get the CDL license reissued.
I am applying for an Identification Card (ID) in the State of New Mexico. By doing so I understand
that I am surrendering my (non-commercial) driver’s license and driving privileges. I understand that,
depending on how much time has passed, I may have to re-take the written and road tests in order to
get the license reissued. A new vision test will be required and regular license fees will apply.
Under New Mexico’s one license law:
I hereby surrender my ________________________________ ❑ Driver or ❑ CDL License. I
understand that the New Mexico Motor Vehicle Division will invalidate it and return it to me for
destruction.
I attest that my ________________________________ ❑ Driver or ❑ CDL License is lost or has been
stolen. I understand that the lost or stolen license, even if found or recovered, will no longer be valid.
I understand that if I am licensed in another jurisdiction, this information will be forwarded to the other
jurisdiction.
I certify that all statements on this form are true. I agree and understand that any misstatement of
material facts may result in the cancellation or denial of my New Mexico Driver License under New Mexico
statute, Section 66-5-24 NMSA, Paragraph A.
Applicant signature
Date
MVD representative
Field office #
Date

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