Fillable Isd 01 - Dmv Address Change Request printable pdf download

Completion of this section is requested but not required. (Virginia Code §2.2-3806)

INFORMATION FOR THE DEPARTMENT OF ELECTIONS

Are you a citizen of the United States of America?

Do you want to apply to register to vote or change your voter registration address?

YES

(INITIAL BOX)

ISD 01 (04/14/2016)

ADDRESS CHANGE REQUEST

Purpose:

Use this form to report a change of address to the Virginia Department of Motor Vehicles.

Instructions: Complete this form and submit it to DMV. The Virginia Department of Motor Vehicles is able to capture and store three different addresses

(residence, mailing, and vehicle registration). It is very important to DMV that we capture your correct address(es).

You may also update your records immediately by changing your address online at

CUSTOMER INFORMATION

CUSTOMER NUMBER (as it appears on your driver's license or identification card)

CUSTOMER BIRTH DATE (mm/dd/yyyy)

FULL LEGAL NAME (last, first, middle, suffix)

ADDRESS FIELD EFFECTIVE DATE (mm/dd/yyyy)

REASON FOR ADDRESS CHANGE (check one)

CORRECTION (typographical error, new 911 address, etc.)

MOVED

NEW RESIDENCE/HOME ADDRESS

•

Enter the address where you actually live. Do not enter a post office box number. Virginia law requires you to provide this address to DMV.

•

If you change either your residence/home address or mailing address to a non-Virginia address, your driver's license and/or photo identification (ID) card

may be canceled.

STREET ADDRESS (no P.O. Box)

CITY

STATE

ZIP CODE

RESIDENCE LOCATION (city or county in which you live)

COUNTRY

NEW MAILING ADDRESS

•

The address shown on your driver's license may be either a post office box, business or residence address in Virginia.

•

If you choose to have a mailing address that is different from your residence address, DMV will send all of your documents to the mailing address.

•

If you change your residence/home address or mailing address to a non-Virginia address, your driver's license and/or photo identification (ID) card may be canceled.

MAILING ADDRESS

CITY

STATE

ZIP CODE

VEHICLE REGISTRATION MAILING ADDRESS

•

Use this section if you own a vehicle that is not located at your residence address and you want DMV to mail the vehicle registration renewal notice to an

address different from those recorded above or if you want to notify DMV of a vehicle that is garaged somewhere other than where you live.

•

If you need to change the address of more than two vehicles, use the additional space on the back of this form

VEHICLE MAKE

TITLE NUMBER

LAST FOUR DIGITS OF VEHICLE IDENTIFICATION

NUMBER (VIN)

MAILING ADDRESS

CITY

STATE

ZIP CODE

GARAGE JURISDICTION (city, county, or town where your vehicle is

COUNTRY

DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy)

located)

VEHICLE MAKE

TITLE NUMBER

LAST FOUR DIGITS OF VEHICLE IDENTIFICATION

NUMBER (VIN)

MAILING ADDRESS

CITY

STATE

ZIP CODE

GARAGE JURISDICTION (city, county, or town where your vehicle is

COUNTRY

DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy)

located)

To record additional vehicles, complete the reverse side of this form

CERTIFICATION

I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that

the information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I

understand that knowingly making a false statement or representation on this form is a criminal violation.

SIGNATURE

DAYTIME TELEPHONE NUMBER

DATE (mm/dd/yyyy)

(

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