Dds23S PDF Details

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Here is the information in regards to the form you were in search of to fill out. It can tell you how long it will require to finish dds23s, what fields you will need to fill in and a few other specific facts.

QuestionAnswer
Form NameDds23S
Form Length8 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min
Other namesgeorgia dds online application, dds application form, dds application, dds online application

Form Preview Example

DDS Mail-in Renewal Options

Thank you for your interest in renewing your Georgia driver’s license, permit, or ID card. The Georgia Department of Driver Services offers renewal by mail options under limited circumstances for U.S. citizen customers who are unable to renew their license in person.

The following customers may utilize this option:

Customers stationed out of state in the military, and their dependents stationed with them

Customers attending school out of the State of Georgia, and their dependents who are with them

Customers temporarily working out of state, and their dependents who are with them

Customers who are physically incapacitated and unable to visit a DDS Customer Service Center

The following general requirements and conditions apply:

You must be a U.S. Citizen.

If you are changing your Georgia address as part of your renewal, you must include proof of the new address. A listing of acceptable documents for this purpose is enclosed.

The customer requesting renewal must complete the DDS-23S form (Application for Driver’s License, Permit, or Identification Card) and have it notarized in Section F.

Customers 60 years of age or older must provide verification that vision requirements are met if applying to renew a driver’s license or permit (enclosed Vision Form must be completed).

Only a 5-year renewal is allowed through this method. 8-year renewal is not allowed by mail.

The customer must provide payment of $20 for a 5-year renewal, payable by check, money order, or credit card.

Processing can take up to ten business days from receipt of your application package. Failure to provide all required documents will delay renewal of your license. Expedited processing is not available. Requests will be processed on a first-come, first-serve basis.

Only renewal of non-commercial licenses, permits, and ID’s is available by mail. Renewal of Commercial Driver’s Licenses (CDL’s) must be done in person at a DDS location.

To complete renewal by mail, please mail all required documents (see reverse side for specific requirements) to the following address along with your payment:

DDS Special Issuance

2206 Eastview Parkway

Conyers, GA 30013

Please make checks or money orders payable to DDS for the renewal fee of $20. A separate check or money order is required for each customer’s renewal request. If paying by credit card, please complete the enclosed Credit Card Authorization Form and return with your application package.

The chart on the back of this page lists the documents required for each type of renewal. Blank application form (DDS-23S), Vision Screening Results form if applicable (DDS-274A), and Credit Card Authorization (DDS-100) form are enclosed for completion.

Please direct any questions to our Customer Contact Center at 1-866-754-3687.

DDS Mail-in Renewal Requirements

Please check the section that applies to you and submit all required documents in that section.

Include this form with your documents.

Note: 8-year renewal is not available by mail.

 

Military

 

Students

1.

DDS-23S application completed and notarized

1.

DDS-23S application completed and notarized

2.

Vision Screening Results Form (DDS-274A)

2.

Vision Screening Results Form (DDS-274A)

 

completed (if applicable)

 

completed (if applicable)

3.

Payment of $20 (check, money order, or credit

3.

Payment of $20 (check, money order, or credit

 

card authorization)

 

card authorization)

4.

Signed letter from Commanding Officer on

4.

Signed letter from an official at the school on

 

military unit letterhead verifying that the

 

school letterhead verifying that the student

 

customer (referenced by name) is currently

 

(referenced by name) is currently enrolled in

 

serving at the location, or that the customer

 

the school, or that the customer (referenced by

 

(referenced by name) is the spouse or

 

name) is the spouse or dependent of a student

 

dependent of a member of the military

 

(referenced by name) currently enrolled in the

 

(referenced by name) currently serving at the

 

school

 

location

 

 

 

Temporarily Employed Out of State

 

Physically Unable to Visit CSC in Person

1.

DDS-23S application completed and notarized

1.

DDS-23S application completed and notarized

2.

Vision Screening Results Form (DDS-274A)

2.

Vision Screening Results Form (DDS-274A)

 

completed (if applicable)

 

completed (if applicable)

3.

Payment of $20 (check, money order, or credit

3.

Payment of $20 (check, money order, or credit

 

card authorization)

 

card authorization)

4.

Signed letter from the customer’s employer on

4.

Signed verification from a licensed physician

 

employer letterhead verifying that the customer

 

that the customer is incapacitated and unable to

 

(referenced by name) is temporarily employed

 

visit a DDS Customer Service Center in person

 

outside the State of Georgia, or that the

 

to renew

 

customer (referenced by name) is the spouse or

 

 

 

dependent of an employee (referenced by

 

 

 

name) temporarily employed outside the State

 

 

 

of Georgia

 

 

Please mail all required documents to the following address along with your payment of $20 (no fee if customer holds a current Veteran license):

DDS Special Issuance

2206 Eastview Parkway

Conyers, GA 30013

APPLICATION FOR DRIVER’S LICENSE, PERMIT,

OR IDENTIFICATION CARD

DRIVER’S LICENSE/PERMIT/ID NUMBER

RESTRICTIONS

CLASSE(S) APPLIED FOR

PLEASE PRINT CLEARLY

 

SECTION A

 

*Response is optional

 

 

 

 

 

 

LAST NAME

 

 

 

SUFFIX

FIRST NAME

 

 

MIDDLE NAME (MAIDEN)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE GEORGIA ADDRESS (STREET ADDRESS OR PO BOX, APT #, CITY, STATE, ZIP CODE)

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE MAILING ADDRESS IF DIFFERENT (STREET ADDRESS OR PO BOX, APT #, CITY, STATE, ZIP CODE TO MAIL LICENSE TO)

 

 

 

 

 

 

 

 

 

 

 

PRIMARY TELEPHONE NUMBER*

SECONDARY TELEPHONE NUMBER*

EMAIL ADDRESS*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF BIRTH

 

 

MALE

HEIGHT

WEIGHT

EYE COLOR

SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FEMALE

 

 

 

 

 

 

 

MONTH

DAY

YEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are you a U.S. citizen?

Yes

No

If No, what is your Alien Registration Number or I-94 Number?

SECTION B (check appropriate boxes and answer applicable questions)

1.List the names of all states or countries, including Georgia, in which you have ever been issued or currently hold a driver’s license, instructional permit, or identification card. For each state or country, list the number, name, and date of birth on the card.

2.List the names of all states or countries, including Georgia, in which your driver’s license, instructional permit, or identification card, or privilege to drive is currently revoked, suspended, canceled, or denied. For each state or country, list the reason and when the action was taken.

3.Is your driver’s license being held by a police officer, law enforcement agency, or court in this state or any other

state or country?

If Yes, explain:

Yes

No

If applying for a driver’s license or instructional permit, do you wear glasses or contact lenses for driving?

Yes

No

Vision Screening Results Field of Vision

With Lenses

Without Lenses

FOR DEPARTMENTAL USE ONLY

DO NOT WRITE IN THIS SPACE

Sight Screener

Right

 

20/

20/

Doctor Certificate

Left

 

20/

20/

Bioptics

Both

 

 

20/

20/

5.

Are you a habitual user of alcohol or any drug to a degree which renders you incapable of safely driving a motor vehicle?

Yes

No

 

 

 

 

6.

Have you ever had seizures, fainting, heart trouble, hearing problems, musculoskeletal performance problems, or respiratory

Yes

No

 

function problems? If Yes, date of last incident: ____ /____ /____

 

 

 

Please describe and provide physician name and city:

 

 

7.Have you ever been diagnosed with any mental disability or disease? If yes, have ever been rendered incompetent?

If so, are you currently restored to competency by the methods provided by law?

8.Do you have any identical brother(s) or sister(s)? If Yes, list full name(s):

Yes

No

Yes

No

Yes

No

Yes

No

9.

Do you wish to have “Organ Donor” displayed on your license or ID?

 

Yes

No

 

 

 

 

 

10.

If applying for a driver’s license or instructional permit, do you want to donate $1 for the prevention of blindness?

N/A

Yes

No

 

 

 

 

 

11.

If you are a male U.S. citizen under the age of 26, have you registered with the Selective Service System?

N/A

Yes

No

The Georgia Department of Driver Services is required to ask all males under the age of 26 who are U.S. citizens whether they have registered with the U.S. Selective Service System, and to report the responses to the U.S. Selective Service System. Your response today does not initiate registration with the U.S. Selective Service System, however, you may be contacted by that agency as a result of your response. Your signature on this application serves as an indication that you have already registered with the U.S. Selective Service System or that you are authorizing the department to forward the necessary information to that agency for such registration. Your signature on this application constitutes consent to be registered with the U.S. Selective System if you are not already so registered. O.C.G.A. §40-5-8.

DDS-23S 1/1/2013

SECTION C – Lost/Stolen License

If you cannot surrender your license for any reason, please check the appropriate box below:

I am unable to surrender my SUSPENDED or REVOKED driver’s license to DDS because it is lost, or for some other reason, surrender is not possible.

I am seeking renewal or replacement of my lost Georgia driver’s license, permit, or identification card. I hereby swear or affirm that my Georgia driver’s license/permit/ID card is not currently revoked, suspended, cancelled, or denied; nor is it being held by a police officer, law enforcement agency, licensing jurisdiction, or court in this or any other state.

SECTION D – Emergency Contact Information

 

Name

Telephone Number

Relationship

 

 

 

 

 

 

 

 

Relative

Friend

 

Other

 

 

 

 

 

 

 

 

 

 

SECTION E – Voter Registration Application

 

 

 

 

 

 

 

1.

Do you want to register to vote?

 

 

 

Yes

No

 

 

 

 

 

 

 

 

2.

If you are requesting a change of address on this application, is the change of address for voter registration purposes also?

Yes

No

 

3.Race (optional):

Asian/Pacific Islander

Black

Hispanic/Latino

White

Other

Your signature in this section serves as an attestation under penalty of perjury that all of the following requirements have been met:

I am a citizen of the United States, and I am a resident of the State of Georgia and of the county or municipality in which I seek to vote.

I am 18 years of age or older or will be 18 years of age within six months of the date of my application.

I am not serving a sentence for having been convicted of a felony involving moral turpitude.

I have not been judicially determined to be mentally incompetent, or if such determination has been made, the disability has been removed.

WARNING: Any person who registers to vote knowing that such person does not possess the qualifications required by law, who registers under any name other than such person’s own legal name, or who knowingly gives false information in registering, shall be guilty of a felony.

Signature

 

Date

/

/

SECTION F – Required Signatures

Under penalty of law, I swear or affirm that I am a resident of the State of Georgia, and the information provided on this application is true and correct. I understand that it is illegal to make false, fictitious, or fraudulent statements on this application. I grant permission to the Department of Driver Services to verify information furnished to the Department through the release of any and all applicant information to third parties which shall include, but not be limited to the U.S. Department of Homeland Security or other public or private entities wherein such disclosure of the information by the Department is not prohibited by law.

Applicant’s Signature

 

 

Date

/

/

NOTARY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SEAL

Notary Signature

 

Date

 

/

/

 

 

The section below must be completed if applicant is under 18 years of age:

 

 

 

 

 

 

I,

the issuance of this driver’s license or instructional permit. and that the information provided here is true and correct.

,hereby certify that I am the parent, guardian, or responsible adult approving I further certify that I have reviewed the information contained in this application,

Signature (Parent, Guardian, or Authorized Person)

 

Date

/

/

Date of Birth

/

/

Driver’s License/Identification/Social Security Number

 

 

 

 

FOR DEPARTMENTAL USE ONLY

Non-Commercial Exam Results

Date

Class

Law

Road Signs

Motorcycle RT

Road Test

General Observations / Retake Reason:

DDS-23S 1/1/2013

Georgia Department of Driver Services

Application for Non-Commercial License

Vision Screening Results

Instructions: Section A must be completed by the applicant. Sections B and C must be completed by an optometrist or ophthalmologist currently licensed to practice in the United States, and the applicant must sign the form in Section C in the presence of the optometrist or ophthalmologist.

SECTION A – CUSTOMER INFORMATION – TO BE COMPLETED BY APPLICANT

Driver’s License Number _____________________ Date of Birth ________________

Applicant’s Full Legal Name _______________________________________________

Applicant’s Complete Address _____________________________________________

______________________________________________________________________

SECTION B – VISUAL EXAMINATION RESULTS

1. Visual Acuity

Right eye – 20/______

Left eye – 20/______

2. Horizontal Field of Vision

Right _______ Degrees

Left _______ Degrees

3. Were corrective lenses used for these results? Yes

Total _______ Degrees

No

Check here if correction is achieved with other than conventional lenses (bioptics). If box is checked, a detailed report must be attached.

IMPORTANT: For proper identification, please have the person whom you have examined sign the report in your presence.

SIGN HERE: ________________________________________________________

Date of examination ____________

Comments __________________________________________________________

___________________________________________________________________

___________________________________________________________________

DDS274A 9/2012

SECTION C – OPTOMETRIST / OPTHALMOLOGIST CERTIFICATION

I __________________________________________________ being licensed to practice in

the state of ____________________, hereby certify that I have personally examined the vision

of the above named, that the results indicated on this form represent a true record of my examination and that he or she signed this form in my presence.

Printed Name of Optometrist/Ophthalmologist

Business Address

Telephone Number

 

License #

Signature of Optometrist / Ophthalmologist

Today’s Date

DDS274A 9/2012

Credit Card Payment Authorization Form

Instructions: To pay by credit card, please complete both sections below.

 

CREDIT CARD HOLDER INFORMATION

 

Please check credit card type:

 

 

 

Visa

MasterCard

Discover

American Express

Credit card number: _____________________________

Expiration date :__________/__________( mm/yy )

Exact name as it appears on the credit card: _________________________________________________________

Billing Zip Code: _________________________________ Amount to be charged: $ _____________________

Primary phone number: ______________________________ Secondary phone number: ____________________

Cardholder Signature: _______________________________________

Date: ___________________

LICENSEE/DRIVER INFORMATION

Name as it appears on Driver's License/ID: _________________________________________________________

Licensee's Drivers License / ID number: ___________________________________________________________

Birth date: ___________ /__________ /____________ (mm/dd/yyyy)

Gender (circle one): Male Female

Please send this credit/debit card payment form and supporting documents to:

Georgia Department of Driver Services

ATTN: Validation

P. O. Box 80447

Conyers, GA 30013

What type of service is this payment for?

DDS-100 12/08

Mail in Renewal – Georgia Address Change

Please provide one document from the list below if your request for renewal includes a change of your address in Georgia.

Utility bill issued within the last sixty (60) days;

In general a utility bill will be for a service provided to the customer that designates their residency or service address. Common examples include telephone, mobile phone, water, sewer, electricity, gas, propane, satellite, cable TV, Internet or garbage collection.

Bank statement issued within the last sixty (60) days;

A bank statement is considered a statement, printout or letter from any financial services company.

Common examples include statements for Checking or Savings accounts, Credit Card statements, credit union statements, loan payments, auto, motorcycle and RV loans.

Currently valid rental contracts and/or receipts for payments made within the last sixty (60) days for rent payments;

This includes rental agreements and leases for a home, apartment, mobile home, dorm, extended stay hotel, etc. Common examples include rental agreement or receipt, general lease agreement, student housing contract, letter from shelters, retirement or medical centers and extended stay hotel receipts.

Employer verification, including, but not limited to, one of the following:

Employer verification may be a formal statement or letter from the company stating the residency address for the employee. Letters should be on company letterhead.

Common examples include Paycheck, Paycheck stub, W-2 form from current or preceding year (these can also be used for SSN verification).

Examples that can only be used to prove residency include letters from the employer, military orders, etc.

Non-expired Georgia driver’s license, permit or identification card issued to the applicant’s parent, guardian, spouse, or child;

For minors and dependents, unexpired GA driver’s license, permit or ID card issued to parent, guardian or spouse residing in same household. For dependent parents, unexpired GA driver’s license, permit or ID card issued to a relative residing in the same household.

Health insurance statement or explanation of benefits for claim;

This includes all health related invoices or statements for service or benefits. Specific information concerning medical conditions should be covered if possible prior to scanning.

Common examples include Health/life insurance statement or invoices, Hospital, clinic, doctor, or lab bills.

State of Georgia or Federal income tax return for current or preceding calendar year;

This includes all information mailed to the customer concerning tax matters from the State of Georgia or Federal Government.

Common examples include tax statements, bills or refund checks.

Annual social security statement for current or preceding calendar year;

This can include any documentation from the Social Security Administration that includes their address. Common examples include Annual Benefit statement, Numident record, Social Security Check.

Medicare or Medicaid statement;

This can include any documentation from the State or Federal Insurance programs.

Common examples Medicare/Medicaid statements, unemployment statements, WIC or other public assistance statements or statements issued by a Federal, State or Municipality.

School record or transcript for current or preceding calendar year;

This includes documentation from all instructional institutions public and private.

Common examples include the DS1, School transcripts, student loans or report cards.

Homeowners insurance policy or bill for current or preceding calendar year;

This includes statements or invoices from insurance or mortgage companies.

Common examples include Homeowners insurance bill, statement of claim, binder or cancellation notice.

Mortgage, payment coupon, deed, or property tax bill for current or preceding calendar year. This includes documentation for household or other real property.

Common examples include household mortgage, settlement or escrow statements, property tax bills, or vehicle registration.

Additional Approved Documents

Voter Registration card; unexpired firearms license (gun permit); unexpired Merchant Marine License; I-797A; I-797C; correspondence from DDS; other documents issued by Federal/State/Municipal government

How to Edit Dds23S Online for Free

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Step 1: Choose the "Get Form Now" button to start out.

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To be able to create the dds application form PDF, provide the details for each of the sections:

writing georgia drivers permit application form part 1

Put the demanded particulars in the DRIVERS LICENSEPERMITID NUMBER, RESTRICTIONS, CLASSES APPLIED FOR, PLEASE PRINT CLEARLY SECTION A, Response is optional, SUFFIX, FIRST NAME, MIDDLE NAME MAIDEN, COMPLETE GEORGIA ADDRESS STREET, COMPLETE MAILING ADDRESS IF, PRIMARY TELEPHONE NUMBER, SECONDARY TELEPHONE NUMBER, EMAIL ADDRESS, DATE OF BIRTH, and MONTH box.

DRIVERS LICENSEPERMITID NUMBER, RESTRICTIONS, CLASSES APPLIED FOR, PLEASE PRINT CLEARLY SECTION A, Response is optional, SUFFIX, FIRST NAME, MIDDLE NAME MAIDEN, COMPLETE GEORGIA ADDRESS STREET, COMPLETE MAILING ADDRESS IF, PRIMARY TELEPHONE NUMBER, SECONDARY TELEPHONE NUMBER, EMAIL ADDRESS, DATE OF BIRTH, and MONTH in georgia drivers permit application form

Be sure to emphasize the necessary information in the List the names of all states or, Is your drivers license being held, Yes, state or country If Yes explain, If applying for a drivers license, Yes, FOR DEPARTMENTAL USE ONLY, DO NOT WRITE IN THIS SPACE, Vision Screening Results, Field of Vision, With Lenses, Without Lenses, Sight Screener Doctor Certificate, Right Left Both, and Are you a habitual user of part.

georgia drivers permit application form List the names of all states or, Is your drivers license being held, Yes, state or country If Yes explain, If applying for a drivers license, Yes, FOR DEPARTMENTAL USE ONLY, DO NOT WRITE IN THIS SPACE, Vision Screening Results, Field of Vision, With Lenses, Without Lenses, Sight Screener Doctor Certificate, Right Left Both, and Are you a habitual user of blanks to fill

The If applying for a drivers license, If you are a male US citizen, Yes, Yes, The Georgia Department of Driver, and DDSS segment can be used to indicate the rights and obligations of both sides.

georgia drivers permit application form If applying for a drivers license, If you are a male US citizen, Yes, Yes, The Georgia Department of Driver, and DDSS fields to fill

Finish by reviewing these areas and submitting the pertinent information: If you cannot surrender your, I am unable to surrender my, I am seeking renewal or, licensepermitID card is not, SECTION D Emergency Contact, Telephone Number, SECTION E Voter Registration, Do you want to register to vote, Relationship Relative, Friend Other, Yes, If you are requesting a change of, Yes, Race optional, and AsianPacific Islander.

part 5 to filling out georgia drivers permit application form

Step 3: Press the Done button to be sure that your completed form is available to be exported to any device you select or mailed to an email you indicate.

Step 4: Create minimally a couple of copies of your file to stay clear of any possible future difficulties.

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