Application For Nevada Driver'S License By Mail Page 2
Download a blank fillable Application For Nevada Driver'S License By Mail in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Application For Nevada Driver'S License By Mail with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3ALL APPLICANTS COMPLETE THIS SECTION
Do you have any disability, illness, missing extremity, or take any medication that could affect your driving ability?............ Yes No
If yes, please explain _________________________________________________________________________________________
Has your driving privilege ever been revoked, suspended, canceled, or denied?.................................................................. Yes No
If yes, State __________________ Date_______________________ Reason_____________________________________________
RENEWAL APPLICANTS MUST ALSO HAVE THIS SECTION COMPLETED
Certificate of Vision Examination
This section must be completed for every person applying to renew a Nevada driver’s license. You may have this report completed by a
licensed physician, ophthalmologist, optician, optometrist, or driver’s license issuing agency in your area. The form must be dated within
the past 90 days and signed by the person who administered the exam. It also needs to show separate visual acuity readings for the right,
left and both eyes, and indicate whether the exam was taken with or without corrective lenses. A prescription for corrective lenses cannot
be accepted in lieu of the required vision examination.
Vision
Without Corrective Lenses
With Corrective Lenses
Right Eye ...................................................................... 20/
20/
Left Eye ........................................................................ 20/
20/
Both Eyes ..................................................................... 20/
20/
Does this person have a progressive disease or condition of the eye?
Yes
No
_______________________________________________________
_______________________________________
Signature: Driver’s License Issuing Agency/Physician/Optometrist
Date of Examination (must be within the last 90 days)
_______________________________________________________
(
) ________________________________
PRINTED Name: Issuing Agency/Physician/Optometrist
Area Code and Phone Number
___________________________________________________________________________________________________
PRINTED Office Address: Issuing Agency/Physician/Optometrist
RENEWAL APPLICANTS 71 OR OLDER MUST ALSO HAVE THIS SECTION COMPLETED
Physical Evaluation
All renewal applicants who will be 71 years of age or older on their driver’s license expiration date must have this report
completed, signed, and dated by a licensed physician no more than 90 days before it is submitted to the Nevada DMV.
Does a medical condition exist that would prevent this patient from safely operating a motor vehicle? .........
Yes
No
If “Yes,” please explain: __________________________________________________________________________
Is this patient taking any medication that would negatively affect his/her ability to drive safely? ....................
Yes
No
If “Yes,” please explain: __________________________________________________________________________
_________________________________
____________________
_________________________________
Physician’s Signature
Physician’s License Number
Date of Physical Evaluation
(Must be within the last 90 days)
_______________________________________________________
(
) __________________________
PRINTED Name of Physician
Area Code and Phone Number
___________________________________________________________________________________________________
PRINTED Office Address of Physician
*NOTE: If you are a US Government employee, active duty military, or dependent of such person,
stationed outside of Nevada and do not have a primary Nevada physical address, please Contact Us for
instructions on your driver’s license renewal or voter registration.
2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal