Fillable Form Dmv-002 - Application For Driving Privileges Or Id Card (Page 2 of 2) in pdf

Affidavits and Signatures Must be Witnessed by an Authorized DMV Representative

INITIAL

AFFIDAVIT

CONSENT FOR MINOR’S LICENSE

I, the undersigned, do hereby consent to the issuance of an instruction permit/license to__________________________,

whose relationship to me is _______________________. I understand that I can be held responsible for any liability caused

by his/her negligence or willful misconduct in the operation of a motor vehicle (NRS 483.300 and/or NRS 486.101). I

understand that I may have the permit/license cancelled and be released from liability by signing a cancellation request at a

DMV Field Services Office. I also understand that before a license is issued, the minor may need to present a DMV-301

Certification of Attendance, a Certificate of Completion from a Nevada DMV-approved Driver Education Course and a

DLD-130 Beginning Driver Experience Log, to the DMV attesting he/she has completed at least 50 hours of behind-the-

wheel driving experience.

INSTRUCTION PERMIT

I, the undersigned, do hereby certify that I understand my instruction permit is valid for up to one (1) year from date of

issuance and I must carry it with me when I am driving. I understand the restrictions on my permit and agree to follow them.

MINOR ORGAN DONOR

I, parent/guardian of minor applicant, understand that unless the anatomical gift is amended or revoked by the donor before

his/her death, I may not amend or revoke the anatomical gift.

_____________________________________________

Signature

NON-USE OF NEVADA DRIVING PRIVILEGE

I, the undersigned, do hereby certify that I have not operated any motor vehicle since ____________________________.

Date

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.

DISCLOSURE STATEMENTS

• The Privacy Act of 1974 is a federal law that authorizes use of your Social Security Number to verify identity. You are required to

submit your Social Security Number so the state may administer laws related to licensing drivers (NRS 483.290).

• The driver’s license or identification card application you are submitting will cause any driving record from your previous state to be

transferred to Nevada.

Due to your change of residency, the license or identification card in your previous state will show as

surrendered.

•

NRS 482.385 requires you to register each vehicle you own and operate now or within 30 days of becoming a resident.

I hereby certify, under penalty of perjury, that all statements in this application are true and correct. I understand

that any and all other driver’s license or identification cards issued by any other jurisdiction will be surrendered

upon issuance of a Nevada license or identification card. I agree and understand that any misstatement of material

facts may cause cancellation and/or denial of my license or identification card under NRS 483.420 and NRS 483.530,

respectively. I further understand that any misstatement of facts may be a misdemeanor or felony under NRS

483.530 and may be punishable pursuant to NRS 193.130.

Applicant Signature

Date

Parent/Guardian Signature if Applicant is Under 18

DL/DAC/ID No.

Sworn Before Me This

Day of

, 20

Authorized DMV Representative ______________________________________________ Tech ID _________________

Signatures must be originals. Photocopies are not acceptable. Changes may not be made to this form once signed.

DMV-002 (Rev. 8/2015 )

Form Dmv-002 - Application For Driving Privileges Or Id Card Page 2

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