Form Mv-16-Application For State Of Maine Identification Card Form
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1
2Application for State of Maine Identification Card
FEE $5.00
(Please Print Clearly)
To obtain an identification card you must provide proof of legal presence in the United States and
documentation of Maine residency.
Name:
________________________________________________________________________________________________________________
First
Middle
Last
Mailing Address:
______________________________________________________________________________________________________
Physical Residence:
___________________________________________________________________________________________________
Date of Birth:
Sex: Male
Female
Social Security Number:
____/____/____
__________________________________
Height: ________Ft. ________In.
Weight: ________ lbs. Hair Color: _____________ Eye Color: _____________
Telephone Number: _______________________
Are you now on active duty with the U.S. armed services and declaring Maine as your legal residence?
YES
If you wish to be an organ and tissue donor, check box to consent to organ and tissue donation.
YES
By checking “yes” above, you are consenting to organ and tissue donation. Your consent to be an organ and
tissue donor will then be clearly indicated on the front of your identification card with a small red heart. For
additional information on organ and tissue donation, you may contact the Maine Transplant Program (207-871-
2000), the National Kidney Foundation of Maine (207-772-7270) or New England Donor Bank (1-800-446-
6362) or visit our website at
It is important to discuss your decision with
your family.
Social Security Number Disclosure Statement
This statement is made in accordance with the Federal Privacy Act of 1974, Section 7(b). Disclosure of your
social security number is required by 29-A MRSA §1301(5) and (6) to apply for or renew a driver’s license or
non-driver identification card. Your social security number will be used solely for identification purposes and
will be kept confidential.
“I understand that knowingly supplying false information on this form is a Class D crime under Title 17-A,
punishable by confinement of up to 364 days or monetary fine of up to $2000.00 or both”
__________________________________________________________________________
_____________________________________
Signature in ink
Date
See reverse for acceptable identification documents
MV-16 Rev 10/2013
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