Form Dl-15 - Occupational Limited License (Oll) Petition
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6DL-15 (7-25-17)
OCCUPATIONAL LIMITED LICENSE (OLL) PETITION
Bureau of Driver Licensing • P.O. Box 68689 • Harrisburg, PA 17106-8689
Please review the following pages for instructions on completing this petition
DRIVER INFORMATION
(Type or print information)
LAST NAME
JR.,ETC.
FIRST NAME
MIDDLE NAME
A
LICENSE EXPIRATION DATE
TELEPHONE NUMBER (BETWEEN 8:00 AM - 4:30 PM)
DATE OF BIRTH (must be listed)
LICENSE NUMBER
MONTH
DAY
YEAR
MONTH
DAY
YEAR
THIS AREA IS FOR CHANGES OR CORRECTIONS ONLY -
(Only fill in the information you want to change or correct)
ADDRESS CHANGE
STREET ADDRESS: A P.O. Box number may be used in addition to the actual residence address, but cannot be used as the only address. See below if using an out-of-state address.
CITY
STATE
ZIP CODE
If you are a registered voter in PA, would you like us to notify your county voter registration office of this change?
YES
NO
❏
❏
If you are not a registered voter, you may contact your county voter registration office.
NAME CHANGE
B
JR.,ETC.
FIRST NAME
MIDDLE NAME
LAST NAME
REASON FOR NAME CHANGE (See FEES Section on instructions page)
❏
❏
❏
Marriage
Divorce
Other (see instructions) ________________________________________________________
OUT-OF-STATE ADDRESS CHANGE. We may not issue driver license products to an out-of-state address, except in the case of an employee of federal
or state government, armed forces personnel, or their families, whose workplace is located outside of Pennsylvania. If this exception applies to you, please
check the appropriate box and include documentation of your status with this application.
I certify that my workplace is located out of state and I am employed by, or am the immediate family of a person employed by:
❏
❏
❏
❏
❏
US Armed Forces
Federal Government
PA State Employment
Relationship to person meeting exemption (check one):
Spouse
Dependent Child
VEHICLE INFORMATION (Attach additional sheets, if needed)
❏
❏
Check the type of OLL you are requesting.
Non-Commercial
Non-Commercial with Motorcycle
Year
Make
Model
License Plate Number
State
1.
2.
3.
4.
5.
C
VEHICLE INSURANCE INFORMATION (Attach additional sheets, if needed)
Insurance Company Name
Policy Number
Effective Date
Expiration Date
1.
2.
3.
4.
5.
NOTE: All vehicles you will drive must have a valid registration and insurance. Proof of Insurance must be sent for all vehicles listed above.
*NOTE: This petition must be mailed to the address listed on the DL-15 and will not be accepted or processed at any PennDOT Driver License Centers.
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