Li-1 - Application For License, Identification Card And Permit
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3STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
DIVISION OF MOTOR VEHICLES
APPLICATION FOR LICENSE,
600 New London Avenue, Cranston, RI 02920-3024
IDENTIFICATION CARD
Phone: 401-462-4368
AND PERMIT (LI-1)
USE BLACK OR BLUE INK ONLY
Transaction Type (Please Select One)
• FOR DMV USE ONLY •
(complete sections A, B, C, D, E*, F* G)
LICENSE
IDENTIFICATION CARD
TIN:
NEW
RENEW
DUPLICATE
UPDATE
OUT-OF-STATE
(complete sections A, B, C, D, E, G)
PERMIT
CHECK
CASH
CC
AMOUNT: ____________
NEW
RENEW
DUPLICATE
UPDATE
EYE TEST RESULTS
WITH CORRECTIVE LENSES?
YES
COMPUTERIZED KNOWLEDGE EXAM (choose one language)
NO
______________
______________
RESULTS:
RESTRICTION:
ENGLISH
SPANISH
PORTUGUESE
AMERICAN SIGN LANGUAGE (ASL)*
IDENTITY ______________________________
OTHER* _________________________
* Pre-scheduled appointment required
P.O.R. ______________________________
MOTORCYCLE
(complete sections A, B, C, D, G)
S.S. CARD ______________________________
PERMIT
DUPLICATE PERMIT
LICENSE
UPDATE
OTHER ______________________________
A.
Applicant’s Information (Complete All Fields)
LAST NAME:
FIRST NAME:
MIDDLE NAME:
SUFFIX:
DATE OF BIRTH:
GENDER:
SOCIAL SECURITY NUMBER:
(MM/DD/YY)
MALE
FEMALE
RI DRIVER’S LICENSE # / R.I. ID # / PERMIT #:
PASSPORT / EMPLOYMENT AUTHORIZATION / RESIDENT ALIEN CARD #:
STREET ADDRESS:
APT/UNIT # or FLOOR #:
CITY/TOWN:
STATE:
ZIP CODE:
RESIDENCE ADDRESS
STREET ADDRESS:
APT/UNIT # or FLOOR #:
CITY/TOWN:
STATE:
ZIP CODE:
MAILING ADDRESS (IF DIFFERENT FROM RESIDENCE)
TELEPHONE:
ACTIVE MILITARY:
100% DISABLED VETERAN:
VETERAN DESIGNATION:
(DD 214 MUST BE SHOWN,
(
)
YES
NO
YES
NO
YES
NO
STATING “HONORABLE DISCHARGE”)
B.
Place Of Birth (Complete All Fields)
COUNTRY:
STATE/PROVINCE:
CITY:
C.
Physical Information (Complete All Fields)
HEIGHT: FT./IN.
WEIGHT: LBS.
EYE COLOR:
(check one)
HAIR COLOR:
(check one)
BROWN
GREEN
GRAY
DICHROMATIC
BLACK
BROWN
WHITE
BALD
RED
BLUE
BLACK
HAZEL
PINK
BLONDE
GRAY
D.
General Questions (Complete All Fields)
1.
ARE YOU A U.S. CITIZEN?
YES
NO
2.
DO YOU WANT TO REGISTER AS AN ORGAN AND TISSUE DONOR?
YES
NO
3. DO YOU WANT TO REGISTER TO VOTE, IF YOU HAVE NOT ALREADY DONE SO (applicable to U.S. citizens only)?
YES
NO
PLEASE ENTER PARTY AFFILIATION BELOW
PARTY AFFILIATION: ___________________________
If you are 18 years old on or before Election Day you may register. If you are at least 16 years of age, you may pre-register.
4. IF YOU ARE TRANSFERRING A LICENSE FROM ANOTHER STATE, PLEASE COMPLETE THE FOLLOWING INFORMATION BELOW:
STATE: __________
LIC. #: _______________
EXP.: _______________
ENDORSEMENTS: _______________
RESTRICTIONS: _______________
NOTICE TO MALES 18 TO 26 YEARS OF AGE:
Pursuant to RI Gen. Laws 31-10-47(a), “(a)ny male, United States citizen or immigrant who is at least eighteen (18) years of age, but less
than twenty-six (26) years of age shall be registered in compliance with the requirements of section 3 of the "Military Selective Service Act",
50 U.S.C. App. 451 et seq., when applying to receive a driver's license, renewal or identification card or renewal.” Pursuant to RI Gen. Laws
31-10-47(b), the applicant recognizes that by submitting this application he is consenting to registration with the Selective Service system,
if so required by federal law.
LI-1
rev. 04/16
CONTINUED ON BACK
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