South Dakota Driver License / I.d. Card Application Form (Page 2 of 2) in pdf

PARENTAL CONSENT MUST BE FILLED OUT AND SIGNED BEFORE A NOTARY PUBLIC OR DRIVER EXAMINER

I certify that I am a Parent/Guardian of (print name) __________________________________________________________

and I hereby grant permission for her/him to:

(Check all that apply)

___ Apply for a South Dakota driver license or permit under the requirements of South Dakota law;

___ Apply for a South Dakota non-driver identification card under the requirements of South Dakota law;

___ Have the organ/tissue donor indicator placed on the driver license, permit, or non-driver identification card.

Parent/Guardian Signature ____________________________________ Print Name __________________________________

Present address ____________________________________________ City, State, Zip Code __________________________

Subscribed and sworn to before me on this___day of __________, 20__

____________________________________________

Notary Public or Driver Examiner

My Commission Expires

State of South Dakota

LOST LICENSE/IDENTIFICATION CARD CERTIFICATION

If you are applying for a duplicate, renewal or transfer of your driver license or identification card, and have lost the last driver

license/identification card issued to you, complete this section:

I have lost or destroyed the last driver license or identification card issued to me by the state of _________________ and it is

not now in my possession. I fully realize that by making this statement, said license/identification card is null and void and may

not be used for operating a motor vehicle or for identification purposes.

Signature ___________________________________________

EXAMINER USE ONLY

RESTRICTIONS (circle)

O F G V X R M E Z B J K W Q

3RD PARTY CDL _____

COMPLETION DATE ______________________

VISUAL ACUITY

DRIVERS ED _____

COMPLETION DATE ______________________

MC SAFETY _____

COMPLETION DATE ______________________

LEFT EYE

BOTH EYES RIGHT EYE

GK _____

COMPUTER CHECKS: CDLIS _____ PDPS _____

20/

CV _____

SAVE _____ SSN

_____

AB _____

TEST REQUIRED: VISION _____ KNOWLEDGE_____ SKILL_____

DT _____

____ W/0 CORR LENS ____ WITH CORR LENS

KNOWLEDGE TEST _______________

TK _____

HZ _____

SKILLS TEST _______________

NEW ____ RENEWAL ____ DUP ____

PV _____

FEE COLLECTED __________ Q_____ C_____ EXAMINER ID________

SB _____

TRANSFER ____ DATA CHANGE ____

LICENSE SURRENDERED? _______________

STATE __________

CLASS __________

COMPLIANT __________ NON-COMPLIANT __________

Documents Presented

U.S. Citizen

Non-Citizen

Social Security

____ Compliant DL/ID

____ Perm Res. Card

____ SS Card

____ U.S. Birth Certificate

____ Foreign Passport & I-94

____ W-2 Form

____ U.S. Marriage Certificate

____ Emp. Auth. Doc.

____ 1099 Form

____ U.S. Passport

Address

____ Payroll stub

____ Certificate of Birth Abroad

____ Address docs

____ Citizen/Natural. Cert.

Notes: ________________________________________________________________________________________________

_____________________________________________________________________________________________________

155,000 copies were printed on recycled paper by PryntComm at a cost of $.026 cents per copy per SDCL 5-18D-15

06-13

South Dakota Driver License / I.d. Card Application Form Page 2

Related Articles

Related forms

Related Categories