Fillable Form Dmv-204 - Application For Nevada Driver'S License By Mail printable pdf download

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Application for Nevada Driver’s License by Mail

NRS 483.347, NRS 483.383-483.384, NAC 483.456-483.4595

Nevada residents who are temporarily residing outside Nevada and meet all other Department requirements may use this form to apply for a

driver’s license renewal or duplicate by mail. Only one renewal may be completed by mail in consecutive renewal periods. Unless you

are a U.S. Government employ ee on active military duty or a dependent of su ch a person, your next license renewal must be completed in a

Nevada DMV office. Within 24 days of your return to Nevada, you are required by law to surrender your driver’s license and obtain a license

which bears your photograph. If you are unsure about your eligibility to renew by mail, please contact the Driver’s License Renewal by Mail

Section at one of the above telephone numbers before submitting your application.

U.S. Government employees on active military duty or a dependent of such persons who wish to renew their license must submit a copy of

an employment or military record (leave/earnings statement) indicating Nevada as your state of residence. Active duty military personnel are

not subject to late penalty fees for a driver’s license expired over 30 days.

If you are no longer a resident of Nevada, surrender your Nevada driver’s license to the Department of Motor Vehicles in the st ate where you

now reside and apply for a driver’s license in that state.

SEE PAGE 2 FOR REQUIRED MEDICAL CERTIFICATIONS

Driver’s License Number ________________________________

Please clearly PRINT the following information:

Full Name (Last, First, Middle) ____________________________________________________________________________________

Date of Birth

Mother’s Maiden Name ______________________________________

Nevada Mailing Address _________________________________________________________________________________________

Nevada Residential Street Address __________________________________________________________________________________

Out-of-State Mailing Address

_________________________________________________________

(license will be mailed to this address)

____________________________________________________________________________________________________________

Description:

Sex ____________

Height ____________

Weight ____________

Hair ____________

Eyes ____________

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.

Would you like to be an organ donor? (This information will be indicated on your license) ..................................................

Yes

Would you like to register to vote or change your voter registration? ....................................................................................

Yes

Would you like your name and address to be released for commercial sales? .....................................................................

Yes

(EFFECTIVE 7/1/2010) If you are a male at least 18 and less than 26 years of age, would you like to register with the Selective Service?

By registering, you will remain eligible for federal student loans, grants, job training benefits, most federal jobs and,

if applicable, citizenship in the United States………………………………………………………………………………………… Yes

Complete this form and mail it to the DMV address noted above with the appropriate fees in the form of a check, money order or

debit/credit card authorization (use form VP205). Do NOT send cash.

RENEWAL ..................................................................... $ 22.00

LATE RENEWAL (expired over 30 days) ....................... $ 32.00

RENEWAL - 65 or Older ................................................ $ 17.00

LATE RENEWAL – 65 or Older...................................... $ 27.00

DUPLICATE ................................................................... $ 17.00

I attest that I am a legal resident of Nevada temporarily residing out of state. I certify under penalty of perjury that all statements

made in this application are true. I understand that any misstatement of facts on this application may cause cancellation or denial

of my driver’s license pursuant to NRS 483.420.

Applicant’s Signature

Date _________________________________

(sign in black ink)

E-Mail Address

Phone No. (out-of-state)

Please complete the appropriate section(s) on the reverse side of this application.

An incomplete application will be returned to you.

DMV-204 (Revised 2/2010 - Previously DLD-4)

Form Dmv-204 - Application For Nevada Driver'S License By Mail

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