South Dakota Driver License / I.d. Card Application Form printable pdf download

SOUTH DAKOTA DRIVER LICENSE / I.D. CARD APPLICATION

(Print in Black Ink)

DRIVER LICENSE NUMBER _____________________________________ SOCIAL SECURITY NUMBER _________________________________________

NAME ____________________________________________________________________________ DATE OF BIRTH _____/ _____/ _____ Sex _______

LAST

FIRST

MIDDLE

SUFFIX

Month

Day

Year

RESIDENTIAL ADDRESS _______________________________________ CITY ________________________ STATE ______ ZIP CODE _______________

Apt #

MAILING ADDRESS ___________________________________________ CITY ________________________ STATE ______ ZIP CODE _______________

(If different than above)

HEIGHT ___ FT. ___ IN. WEIGHT _________ EYE COLOR __________ COUNTY _______________ DAYTIME PHONE NUMBER ___________________

EMAIL ADDRESS ___________________________

I AM APPLYING FOR:

___ DRIVER LICENSE ___ INSTRUCTION PERMIT ___ NON-DRIVER ID CARD

CLASS: ___ Class 1:

___ Class 2:

___ Class 3:

(Car/Light Truck/Moped)

(Car/Light Truck/Moped/Motorcycle)

(Motorcycle Only)

COMMERCIAL DRIVER LICENSE APPLICANTS ONLY:

I am applying for: ___ CLASS A

___ CLASS B:

___ CLASS C

(Combination Vehicle)

(Heavy Straight Vehicle)

(Commercial Vehicle under 26,001 lbs.

with applicable endorsements)

COMMERCIAL ENDORSEMENTS: ___ PASSENGER (P)

___ DOUBLE/TRIPLE TRAILER (T)

___ HAZARDOUS MATERIALS (H)

___ SEASONAL CDL (W)

___ 90 day or ___ 180 day

___ SCHOOL BUS (S)

___ TANK VEHICLES (N)

___ COMBINATION TANK/HAZARDOUS MATERIALS(X)

___ MOTORCYCLE (3)

1. YES____ NO____ I will be operating a vehicle equipped with air brakes.

2. Check one of the following: (NI) _____ I drive interstate and am subject to 49 CFR PART 391 (present valid DOT medical card).

(EI) _____ I drive interstate and am excepted from 49 CFR PART 391.

(EA) ____ I drive intrastate only and am not subject to 49 CFR Part 391.

(NA) ____ I drive intrastate and am subject to 49 CFR Part 391 in accordance with SDCL 32-12A-24 (schoolbus endorsed)

(present valid DOT medical card)

SCHOOL BUS APPLICANTS: Have you been convicted of DUI within the past three years, or have you ever been

3. YES____ NO____

convicted of any offense involving moral turpitude?

1. YES____ NO____ Do you have a Living Will and want it to be indicated on your license?

2. YES____ NO____ Do you have Durable Power of Attorney for Health and want it to be indicated on your license?

3. YES____ NO____ Are you currently behind in child support payments of $1,000 or more?

4. YES____ NO____ Are you currently licensed to drive?

If YES, in what state or country?______________ LICENSE # ______________________________________________________

5. YES____ NO____ Do you currently have an Identification Card issued in any other state?

If YES, in what state/country __________________ID # ________________

6. YES____ NO____ Do you currently, or have you ever had your right to drive suspended, revoked, canceled, disqualified or denied?

If YES, When _____________________________ Which State? _____________ Reason? _______________________________

7. YES____ NO____ Have you, in the past twelve months, experienced any epileptic or narcoleptic episodes or other convulsions, seizures,

or blackouts? If YES, the date of the last episode. ________________________________________________________________

8. YES____ NO____ Are you currently on active duty, or the dependent of a person on active duty, in the U.S. Armed Forces? (Must show ID)

9. YES____ NO____ Have you ever been known by any other name, including maiden name? If YES, what name(s) _____________________________

10. YES____ NO____ Are you a United States citizen? (If no, you must show documents proving lawful status.)

11. YES____ NO____ Are you an honorably discharged U.S. Veteran and want it to be indicated on your license or ID? (Must show DD214)

12. YES____ NO____ Have you held a license in any other state, province, or country over the last 10 years? If YES, list where. ____________________

 In the event of my death, I would like to be an organ/tissue donor.

To remove an existing donor indicator on your card write "remove" here and initial______________________.

I UNDERSTAND that I, as an operator of a motor vehicle in this State, have consented to the withdrawal of my blood or other bodily substance in accordance with SDCL 32-23-10,

which requires me to submit to the withdrawal of my blood or other bodily substances subsequent to being arrested for a violation of SDCL 32-23-1. I declare and affirm under the

penalties of perjury (2 years imprisonment and $4,000 fine) that this application has been examined by me, and to the best of my knowledge and belief, is in all things true and correct.

Any false statement or concealment of any material facts subjects any license or ID to immediate cancellation. I consent to the release of my driving record information.

I certify that, if required by law, I have already registered with the Selective Service; or if I have not registered I am consenting to registration as required by Federal law. I authorize

the Department of Public Safety to forward my personal information required for such registration to the U.S. Selective Service System pursuant to SDCL 32-12-17.12 and SDCL 32-

12A-7.1.

VOTER REGISTRATION

YES____ NO____

Do you want to register to vote or change your name, address or party affiliation? Information provided on this voter registration

application will be forwarded to your county auditor.

If residence address is a post office box, rural box, or general delivery, you must give the location of your residence: _________________________________

_____________________________________________________________________________________________________________________________

Choice of Party ___________________________________.

I declare, under penalty of perjury (2 years imprisonment and $4,000 fine), that:

* I am a citizen of the United States of America;

* I actually live at and have no present intention of leaving the above address;

* I will be 18 on or before the next election;

* I have not been judged mentally incompetent;

* I am not currently serving a sentence for a felony conviction; and

* I authorize cancellation of my previous registration, if applicable.

I wish to be registered as shown above. I was last registered with the following name and address which will be cancelled:

Last

First