Form Dl-54a - Application For Initial Identification Card - Pennsylvania Department Of Transportation
Download a blank fillable Form Dl-54a - Application For Initial Identification Card - Pennsylvania Department Of Transportation 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 Form Dl-54a - Application For Initial Identification Card - Pennsylvania Department Of Transportation 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
2DL-54A (7-17)
APPLICATION FOR INITIAL IDENTIFICATION CARD
Bureau of Driver Licensing • P.O. Box 68272 • Harrisburg, PA 17106-8272
ALL SECTIONS MUST BE COMPLETED
A
JR./ETC
LAST NAME
MIDDLE NAME
FIRST NAME
SEX
Telephone Number
DATE OF BIRTH
HEIGHT
SOCIAL SECURITY NUMBER OR DRIVER'S LICENSE NUMBER
(8:00 a.m. to 4:30 p.m.)
MONTH
DAY
YEAR
FEET
INCHES
BLUE
BROWN
GREEN
HAZEL
PINK
BLACK
GRAY
DICHROMATIC
OTHER
EYE COLOR (please check one):
________________________________
CURRENT STREET ADDRESS - A Post Office Box number may be used in addition to the actual residence address, but cannot be used as the only address.
PA
STATE
ZIP CODE
CITY
If this is a change of address and you are a registered voter in PA, would
If you are not a registered voter, you may
YES
NO
you like us to notify your county voter registration office of this change?
contact your county voter registration office.
Do you hold a current/valid out-of-state driver's license?
If yes, you must surrender your out-of-state valid license.
YES
NO
Pennsylvania strongly supports organ and tissue donation because of its life-saving and life-enhancing opportunities.
f under 18)
ADD (Parental consent required i
REMOVE
B
CHECK APPLICABLE BLOCK BELOW:
FEE INFO.
$30.50
1.
I HAVE NEVER HELD A PA DRIVER'S LICENSE/PERMIT OR IDENTIFICATION CARD AND I AM APPLYING FOR AN
INITIAL IDENTIFICATION CARD. (You must apply in person at any Driver License Center.)
2.
I CURRENTLY HOLD A PA DRIVER'S LICENSE/PERMIT AND AM APPLYING FOR A NON-DRIVER IDENTIFICATION
CARD FOR THE FOLLOWING REASON:
FREE
I am surrendering my driving privilege for health reasons that may affect my ability to safely operate a motor vehicle.
I understand that my license will not be reissued until I successfully complete the appropriate examination.
(If you have not
already surrendered your Driver's License/ Learner's Permit, please attach it to this application.)
I am voluntarily surrendering my driving privilege with the understanding that it will be retained for a minimum of six
months as required by 67 Pa. Code 93.2. It is understood that I will not be permitted to apply for my driver's license,
$30.50
Class A through M inclusive, for a period of six months. (Attach Driver's License/ Learner's Permit.)
A VOLUNTARY
SURRENDER WILL NOT BE ACCEPTED AS CREDIT TOWARD A SUSPENSION, RECALL, CANCELLATION, OR REVOCATION.
As a result of my parent's or guardian's withdrawal of consent for me to drive a motor vehicle (Attach Driver's License/
$30.50
Learner's Permit.)
PLEASE NOTE: A DL-100A MUST ACCOMPANY THIS APPLICATION.
As a result of the suspension of my driver's license. License MUST be attached. If not, you MUST complete the
ACKNOWLEDGEMENT: I ________________________________________________________________________________________
(PRINT NAME)
hereby acknowledge that my driving privilege is suspended/revoked/disqualified in Pennsylvania and my
A.
License issued by Pennsylvania has expired.
$30.50
B.
License issued by Pennsylvania has been:
Lost
Stolen
Mutilated
When?______________________ How? ________________________________________________________________
C.
License issued by Pennsylvania has been surrendered to or confiscated by the Police/Court.
When?______________________ What Police Department/County? _______________________________________
D.
License issued by Pennsylvania has been previously surrendered to PennDOT to serve an existing period of suspension.
When? ______________________ Why were you suspended? ____________________________________________
3.
$30.50
I DESIRE TO HAVE AN IDENTIFICATION CARD ALONG WITH MY CURRENT/EXPIRED PA DRIVER'S LICENSE/PERMIT.
C
CERTIFICATION (SIGN AND ENTER DATE OF APPLICATION)
REQUEST FOR ORGAN DONOR DESIGNATION
PARENTAL CONSENT
For Veterans wishing to add the Veterans Designation to their Driver's License or ID
Card: I certify under penalty of law that I am a qualified applicant and hereby request it be
I am under the age of 18 years and I hereby request Organ Donor
added to my product. I understand that misrepresentation will result in the cancellation of my
designation on my Pennsylvania I.D. Card. Applicants 18 years of age
identification card.
or older will have the opportunity to request Organ Donor designation
I certify under penalty of law that all information given on this application is true and correct. I hereby
on my Pennsylvania I.D. Card.
authorize the Social Security Administration to release to the Department of Transportation information
concerning my Social Security Identification Number for the purpose of identification. If using a
I hereby certify that I am a
Parent,
Guardian,
Messenger Service, I hereby authorize the Department to furnish them with my driving record for the
Person in Loco Parentis, or
Spouse at least 18 years of age and
purpose of processing this form.
I:
Do give consent
I wish to contribute $1.00 to the Organ Donation Awareness Trust Fund (see reverse).
I wish to contribute $3.00 to the Veterans' Trust Fund (see reverse).
Do NOT give consent for applicant's request for Organ
X
X
SIGN
Donor designation.
SIGN
HERE
APPLICANT'S SIGNATURE IN INK
DATE
HERE
WARNING: Misstatement of Fact is a misdemeanor of the third degree punishable by a fine of up to $2,500 and/or
SIGNATURE OF PARENT, GUARDIAN, PERSONS IN LOCO PARENTIS, OR SPOUSE AT LEAST 18 YEARS OF AGE
DATE
imprisonment up to 1 year (18 Pa. C, Section 4904 [b]).
TOTAL
$
PAID BY:
Check
Money Order
Payable to PennDOT (PennDOT does not accept cash, credit or debit cards)
D
DEPARTMENTAL USE ONLY
ID NUMBER ______________________________________________
RESIDENCY REQUIREMENTS (LIST TWO) 1. ________________________________________ 2. _________________________________________
VERIFICATION OF BIRTH DATE & IDENTITY
Birth certificate
Other _________________________________________________________
X
SIGN
HERE
SIGNATURE OF EXAMINER
DATE
BADGE NO.
EXAM CENTER
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Mv-904so - Application For Special Organization Registration Plate - Department Of Transportation
Legal
Form Mt-103 - Application Senior Citizen Transit Identification Card - Pennsylvania Department Of Transportation
Legal
Form Drc 20 - Application For Industrial Radiography Certification - Louisiana Department Of Environmental Quality
Legal
Form Dr-18 - Application For Amusement Machine Certificate - Florida Department Of Revenue
Financial
Form Hpc - 2005 Application For Homestead Preservation Credit - Missouri Department Of Revenue
Financial
Related Categories
Parent category: Legal