Form Dl-174 - Voluntary Surrender - Texas Department Of Public Safety printable pdf download

Form Dl-174 - Voluntary Surrender - Texas Department Of Public Safety

VOLUNTARY SURRENDER

, holder of Texas driver license or identification card number

Printed Name

, hereby voluntarily surrender the above driver license / identification card and

ask that it be cancelled for the reason indicated.

Driver License / Identification Card

I no longer wish to be licensed to drive a motor vehicle upon the streets and highways.

I am no longer physically qualified and/or mentally alert to safely operate a motor vehicle upon the streets and highways.

I no longer wish to be licensed to drive a motor vehicle because of motor vehicle liability insurance reasons.

I am required to obtain a driver license and / or an identification card under the provisions of §521.272, TRC, sex

offender registration.

I no longer wish to have an identification card.

I do solemnly swear, affirm, or certify that I am the person named herein and this request is made in the interest of my

personal safety and the welfare of others by my own initiative or in compliance with other provisions of Texas law.

Signature

Address

Date

Notary Public in and for the State of Texas /Authorized Officer

DL-174 (Rev. 10/16)

Form Dl-174 - Voluntary Surrender - Texas Department Of Public Safety