Form Dsmv 30 (Rev. 10/14) - State Of New Hampshire - Record Change Request Form
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1John J. Barthelmes
STATE OF NEW HAMPSHIRE
Commissioner of Safety
DEPARTMENT OF SAFETY
DIVISION OF MOTOR VEHICLES
Richard C. Bailey Jr.
23 HAZEN DRIVE, CONCORD, NH 03305-0001
Director of Motor Vehicles
(603) 227-4000
RECORD CHANGE REQUEST
Note: This request will change data on all DMV records (Registration, Driver License, Title, etc.)
Please complete form accordingly for permanent changes only.
1. Person’s Information: (Please Print)
NAME:
FIRST
MIDDLE
LAST
DATE OF BIRTH
DRIVER LICENSE NUMBER / NON
BEST CONTACT PHONE
EMAIL ADDRESS
DRIVER IDENTIFICATION NUMBER
NUMBER (RECOMMENDED)
2. Address Change:
If you would like a replacement license/ID with the updated information go to any
DMV Office and you may purchase a replacement at a cost of $3.00.
MAILING ADDRESS:
STREET
CITY/TOWN
STATE
ZIP CODE
Check this box if the legal address is the same as the mailing, if different please complete legal address below.
LEGAL ADDRESS:
STREET
CITY/TOWN
STATE
ZIP CODE
Check this box if you wish to have your legal address appear on the back of your driver license or ID.
NOTE: If an updated license is requested, applicant must appear in person and present current license to any DMV office, at a cost of $3.00.
Please check if you wish to add the Veteran Indicator.
Office Use only: Cash □ Check □ Credit □
3. Name Change:
Must appear in person at any DMV Office with supporting documentation.
Marriage Certificate, Divorce decree, Adoption decree, Court decree, Name Change Petition from Probate Court, Passport.
NEW NAME:
FIRST
MIDDLE
LAST
SUFFIX
(Jr. Sr. I, II, etc)
4. Other Personal Identification Information:
To change Date of Birth you must appear in person
at any DMV Office with supporting documentation. Original or certified copy of Birth Certificate, valid
Passport or valid Military ID.
Height
Weight
Eye Color
Hair Color
Gender
Date of Birth (mm/dd/year)
5. Donor Information:
Check Here
To Consent to Organ Donation pursuant to RSA 263:41.
Donation information will be provided to federally designated organizations so that your decision to donate may be
honored.
Check here
to remove your consent to Organ and Tissue donation.
I, the undersigned applicant, certify under penalty of unsworn falsification pursuant to RSA 641:3, all
information provided is correct and true.
Signature:_________________________________________
Date:_______________________________
DSMV 30 (Rev 10/14)
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