Looking for a District Of Columbia Legal Forms And Templates? Download it for free!

Form Dc Dmv-Lpc-001 - 6-Month Dc Residency Certification - District Of Columbia Department Of Motor Vehicles

GOVERNMENT OF THE DISTRICT OF COLUMBIA

DEPARTMENT OF MOTOR VEHICLES

6-MONTH DC RESIDENCY CERTIFICATION

APPLICANT INFORMATION

Last Name

First Name

Middle Name

Date of Birth

Address

Apt/Unit Number

City/State

Zip Code

, DC

ASHINGTON

Telephone Number with Area Code

E-mail Address

Applicants applying for a Limited Purpose Credential must certify residence in the District of Columbia for at least six (6)

months prior to the date of application. To certify, applicant must provide proof of current DC address and two (2)

documents from category below issued at least six (6) months prior to application date.



Homeowner or Renter insurance policy reflecting



Utility Bill (water, gas, electric, oil or cable)

name and DC address



Unexpired Lease or Rental agreement with the



Telephone Bill

name of the Applicant as a lessee, permitted

resident, or renter



DC Property Tax Bill

Deed or Settlement Statement



DMV Approved Document with photo from

Official Mail - received from Federal or DC

Court Services and Offender Supervision

Agency other than DC DMV (Must include

applicant’s first and last name, complete

(CSOSA) or DC Department of Corrections

(Must certify residence)

address, as well as the envelope and contents)



DC DMV Approved Letter from Certified Social

DC DMV Proof of Residency Form

Service Provider (Identification Card Only)



Bank Statement

Any person using a fictitious name or address and knowingly making any false statement on this application is in violation of DC Law

and subject to a fine of not more than $1,000 or 180 days imprisonment or both. (D.C. Official Code §22-2405)

I hereby certify that the information contained on this application is true and correct.

Applicant’s Signature:

Date: _______________

FOR DMV OFFICIAL USE ONLY

DMV E

:___________________________________________D

:____________

XAMINER

IGNATURE

ATE

Visit our website:

or call 311 in DC or 202-737-4404 for additional information.

To report waste, fraud, or abuse by any DC Government Agency or official, call the Office of the DC Inspector General at 1-800-521-1639.

DC DMV-LPC-001 Version 03/7/2014

Form Dc Dmv-Lpc-001 - 6-Month Dc Residency Certification - District Of Columbia Department Of Motor Vehicles

Related Articles

Related forms

Related Categories