Dl 14A 2021 Details

The Dl 14A Form is an important document for businesses in the state of California. This form is used to report information about payments made to vendors and contractors. It's essential that businesses complete and submit this form on a regular basis, as it helps the government keep track of spending trends. Here's everything you need to know about the Dl 14A Form, including where to find it and how to complete it.

We have collected some useful information about the dl 14a form. It can be helpful to know its length, the average time needed to complete the form, the blanks you will have to fill in, etc.

QuestionAnswer
Form NameDl 14A Form
Form Length2 pages
Fillable?Yes
Fillable fields95
Avg. time to fill out19 min 34 sec
Other nameshow to fill dl 14a, dl 14a application for texas driver license, dl 14a 2021, texas dl 14a form

Form Preview Example

DL-14A - TEXAS DRIVER LICENSE OR IDENTIFICATION CARD APPLICATION (ADULT - 17 YEARS 10 MONTHS OF AGE AND OLDER)

NOTICE: All information on this application must be in INK. Applications held for 90 days only.

DPS CANNOT REFUND PAYMENT ONCE APPLICATION IS SUBMITTED.

FOR DEPARTMENT USE ONLY

RESTRICTIONS/ENDORSEMENTS

ASSIGNED # ___________________

Application for: _____ Driver License _____ Identification Card

Class (select one): ___ A ___ B ___ C Motorcycle: ___ Y ___ N

Select one: _____ Original

_____ Renewal

_____ Replacement

_____ Address or Name Change

 

 

 

 

APPLICANT INFORMATION

 

 

 

 

 

 

 

Last Name:_________________________________________ First Name:_________________________________________ Middle Name: ___________________________

Suffix:__________________________________ Birth Surname (Maiden):_________________________________________

 

-

-

SSN:________________________________

Date of Birth (mm/dd/yyyy):_____________________

Sex (select one): ___ Male ___ Female

Height: ______ Ft.

______ In.

Weight: __________ Lbs.

Eye Color (select one):

____ Blue

____ Brown

____ Gray

____ Hazel

____ Green

____ Black

____ Maroon

____ Pink

 

 

Hair Color (select one): ____ Black

____ Red

____ Gray

____ Brown

____ Blonde

____ Bald

____ White

 

 

 

Race (select one): ____ (AI) Alaskan or American Indian

____ (AP) Asian or Pacific Islander

____ (BK) Black

____ (W) White

 

 

Ethnicity (select one):

____ (H) Hispanic Origin

____ (O) Not of Hispanic Origin ____ (U) Unknown

 

 

 

Place of birth: City:__________________________________ State: _____ County:___________________

Country:_______________________________________________________

Father’s Last Name:_________________________________________________________ Mother’s Maiden Name: ____________________________________________

CONTACT INFORMATION

Residence Address: _______________________________________________________________________________________________________________________

City:_______________________________________________________ State: _______ Zip Code:____________ County: _______________________________________

Mailing Address: __________________________________________________________________________________________________________________________

City:_______________________________________________________ State: _______ Zip Code:____________ County: _______________________________________

Home Phone:________________________ Other Phone:________________________ Email: _____________________________________________________________

In the event of injury or death would you like to provide up to two (2) emergency contacts? If yes, please list:

a)Name ____________________________________ Phone Number __________________ Address _________________________________________________________

b)Name ____________________________________ Phone Number __________________ Address _________________________________________________________

Alternate Address: (Peace Officer or State / Federal Judge only)

Address: __________________________________________________________________________________________________________________________________

City:_______________________________________________________ State: _______ Zip Code:____________ County: _______________________________________

REQUIRED INFORMATION FROM ALL APPLICANTS

YES NO

1.

___

___

Are you a citizen of the United States? If no, go to question 3.

 

 

2.

___

___

If you are a U.S. citizen, would you like to register to vote? If registered, would you like to update your voter information?

 

 

 

I understand that giving false information to procure a voter registration is perjury, and a crime under state and federal law. Conviction of this

 

 

 

crime may result in imprisonment up to 180 days, a fine up to $ 2,000, or both. PLEASE READ ALL THREE STATEMENTS TO AFFIRM BEFORE

 

 

 

SIGNING.

 

 

 

 

 

 

 

I am a resident of the county provided above, and a U.S. citizen; I have not been finally convicted of a felony, or if a felon, I have completed all of my

 

 

 

punishment including any term of incarceration, parole, supervision, period of probation, or I have been pardoned; And I have not been determined by a final

 

 

 

judgment of a court exercising probate jurisdiction to be totally mentally incapacitated or partially mentally incapacitated without the right to vote.

 

 

 

By providing my electronic signature, I understand the personal information on my application form and my electronic signature will be used for submitting

 

 

 

my voter’s registration application to the Texas Secretary of State’s office. Wanting to register to vote, I authorize the Department of Public Safety to transfer

 

 

 

this information to the Texas Secretary of State.

 

 

3.

___

___

Are you a veteran?

If no, go to question 4.

 

 

 

___

___ a.) Are you a 60% disabled Veteran receiving compensation and want to waive the application fee? (Proof of disability required)

 

___

___ b.) Do you want a Veteran designator on your DL or ID, or

 

 

 

___

___ c.) Are you 50% disabled or are you 40% and have had a lower extremity amputated and want a Disabled Veteran designator on your DL or ID? (Proof of

 

 

 

honorable discharge required; some acceptable documents are DD214/215, NGB22, VA disability letter, Veteran Identification card, proof of service/

 

 

 

verification of honorable service card. Proof of disability is required for Disabled Veteran designator)

 

___

___ d.) If you want a Veteran or Disabled Veteran designator, do you want the branch of service shown on your DL or ID? If yes, select one:

 

 

 

_____ Army

_____ Air Force

_____ Coast Guard

_____ Marines

_____ Navy

4.

___

___

Do you have a health condition that may impede communication with a peace officer? (Physician must complete form DL-101).

5.

___

___

Would you like to register as an organ donor?

 

 

6.

___

___

Do you want to donate $1.00 to the Blindness Education Screening and Treatment Program?

7.

___

___

Do you want to support the Glenda Dawson Donate Life Texas donor registry? If yes, please indicate a donation amount of $1 or more $_______.00.

8.

___

___

Do you want to support Texas Veterans?

If yes, please indicate a donation amount of $1 or more $_________.00.

9.

___

___

Do you want to support survivors of sexual assault? If yes, please indicate a donation amount of $1 or more $_________.00 to help fund the testing of sexual

 

 

 

assault evidence collection kits (rape kits).

 

 

10. ___

___

Do you want to support the issuance of a DL/ID for foster or homeless youth? If yes, please indicate a donation amount of $1 or more $_________.00 to

 

 

 

exempt this population from paying any fees.

 

 

DL-14A (Rev. 7/2020)

 

APPLICATION CONTINUED ON BACK

REQUIRED INFORMATION FROM DRIVER LICENSE APPLICANTS ONLY (FOR CONFIDENTIAL USE OF THE DEPARTMENT ONLY)

MEDICAL HISTORY QUESTIONS

YES NO

1.

___

___

Do you currently have or have you ever been diagnosed with or treated for any medical condition that may affect your ability to safely operate a motor

 

 

 

vehicle?

 

 

 

Examples, including but not limited to: Diagnosis or treatment for heart trouble, stroke, hemorrhage or clots, high blood pressure, emphysema (within the past

 

 

 

two years) progressive eye disorder or injury (i.e., glaucoma, macular degeneration, etc.) loss of normal use of hand, arm, foot or leg blackouts, seizures, loss

 

 

 

of consciousness or body control (within the past two years) difficulty turning head from side to side loss of muscular control stiff joints or neck inadequate

 

 

 

hand/eye coordination medical condition that affects your judgment dizziness or balance problems missing limbs

 

 

 

Please explain and identify your medical condition: ________________________________________________________________________________________________________________________

2.

___

___

Do you have a mental condition that may affect your ability to safely operate a motor vehicle? If yes, how? Please explain:

 

 

 

____________________________________________________________________________________________________________________________________________________________________________________

3.

___

___

Have you ever had an epileptic seizure, convulsion, loss of consciousness, or other seizure?

4.

___

___

Do you have diabetes requiring treatment by insulin?

5.

___

___

Do you have any alcohol or drug dependencies that may affect your ability to safely operate a motor vehicle or have you had any episodes of alcohol or drug

 

 

 

abuse within the past two years?

6.

___

___

Within the past two years have you been treated for any other serious medical conditions? Please explain:

 

 

 

____________________________________________________________________________________________________________________________________________________________________________________

7.

___

___

Have you EVER been referred to the Texas Medical Advisory Board for Driver Licensing?

REQUIRED INFORMATION FROM FIRST TIME DRIVER LICENSE APPLICANTS ONLY

DRIVER HISTORY INFORMATION

YES NO

1.

___

___

Have you ever had a driver license, identification card or instruction permit in Texas or any other state?

 

 

 

List state(s): _____________________________________________________________________________________________________________________________________________________________________

 

 

 

Number(s): _____________________________________________ When? _________________________________________________________________________________________________________

2.

___

___

Are you enrolled in or have you completed an approved driver education course?

3.

___

___

Is your driver license or driver privilege CURRENTLY or EVER been suspended, revoked, cancelled, denied or disqualified in ANY state?

 

 

 

State?_____________ When?___________________________ Why? ______________________________________________________________________________________________________________

VEHICLE REGISTRATION AND INSURANCE INFORMATION

1.

___

___

Do you own a motor vehicle that is required to be registered? (Texas Transportation Code section 502.040)

2.

___

___

Do you own a motor vehicle that is required to have liability insurance OR other proof of financial responsibility in compliance with the Motor Vehicle Safety

 

 

 

Responsibility Act? (Texas Transportation Code section 601.051)

NOTICE: The information on this application is required by the Texas Driver License Act, Texas Transportation Code Chapter 521. Failure to provide the information is cause for refusal to issue a driver license or identification card, and in some cases, cancellation or withdrawal of driving privileges. False information could also lead to criminal charges with penalties of a fine up to $4,000.00 and/or jail.

SOCIAL SECURITY NUMBER COLLECTION DISCLOSURE

Disclosure of your social security account number is mandatory for identification card and driver license applicants, but voluntary for election identification certificate applicants. This information is solicited pursuant to 42 U.S.C. section 405(c)(2)(C)(i), 42 U.S.C. section 666(a)(13)(A), 6 C.F.R. section 37.11(e), 49 C.F.R. section 383.153, Texas Family Code section 231.302(c)(1), and Texas Transportation Code sections 521.142 and 522.021. The Department will use social security number information for identification purposes and will only release the number as statutorily authorized by Texas Transportation Code section 521.044.

UNITED STATES SELECTIVE SERVICE

Any male at least 18 but younger than 26 years of age submitting this application consents to registration with the United States Selective Service System. Alternative options for those who object to conventional military service for religious or other conscientious reasons may be found at: https://www.sss.gov/About/Alternative-Service. By submitting this application, I am consenting to registration with the United States Selective Service System if my registration is required by federal law.

DO NOT SIGN BELOW UNTIL INSTRUCTED TO DO SO BY NOTARY PUBLIC OR DRIVER LICENSE EMPLOYEE.

CERTIFICATION

I do solemnly swear, affirm, or certify that I am the person named herein and that the statements on this application are true and correct. I further certify my residence address is a (select one): ___ single family dwelling, ___ apartment, ___ motel, ___ temporary shelter. I agree to immediately report to the Texas Department of Public Safety any changes in my medical condition which may affect my ability to safely operate a motor vehicle. I further understand that I am required by law to report any change of name or address to the Department of Public Safety within thirty days.

X Signature of Applicant _____________________________________________________ Date _________________________

Sworn to and subscribed before me this _______________ day of _________________________________________, _____________

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

DL-14A (Rev. 7/2020)

How to Edit Dl 14A Form

This PDF editor allows you to fill in documents. You don't have to undertake much to enhance texas dl 14a form forms. Basically comply with the next steps.

Step 1: This website page has an orange button that says "Get Form Now". Hit it.

Step 2: Now, you are on the document editing page. You may add content, edit present details, highlight certain words or phrases, place crosses or checks, add images, sign the document, erase unrequired fields, etc.

Provide the content required by the application to get the file.

dl14a blanks to fill in

In the box In the event of injury or death, a) Name, b) Name, Alternate Address: (Peace Officer, Address:, REQUIRED INFORMATION FROM ALL, YES NO, ___ Are you a citizen of the, ___ If you are a U, I understand that giving false, ___ Are you a veteran, and ___ a note the particulars which the program asks you to do.

part 2 to finishing dl14a

It's important to put down specific details inside the box ___ Do you want to donate $1, ___ Do you want to support the, ___ Do you want to support Texas, ___ Do you want to support, assault evidence collection kits, ___ Do you want to support the, exempt this population from paying, DL-14A (Rev, and APPLICATION CONTINUED ON BACK.

dl14a ___ Do you want to donate $1, ___ Do you want to support the, ___ Do you want to support Texas, ___ Do you want to support, assault evidence collection kits, ___ Do you want to support the, exempt this population from paying, DL-14A (Rev, and APPLICATION CONTINUED ON BACK blanks to fill

The vehicle, Please explain and identify your, ___ Do you have a mental condition, ___ Have you ever had an epileptic, ___ Do you have diabetes requiring, ___ Do you have any alcohol or, abuse within the past two years, ___ Within the past two years have, ___ Have you EVER been referred to, REQUIRED INFORMATION FROM FIRST, DRIVER HISTORY INFORMATION, YES NO, ___ Have you ever had a driver, List state(s):, Number(s):, and ___ Are you enrolled in or have section is the place to place the rights and responsibilities of all sides.

Entering details in dl14a stage 4

Prepare the form by looking at the next sections: Is your driver license or driver, State, VEHICLE REGISTRATION AND INSURANCE, ___ Do you own a motor vehicle, ___ Do you own a motor vehicle, Responsibility Act, NOTICE: The information on this, SOCIAL SECURITY NUMBER COLLECTION, and UNITED STATES SELECTIVE SERVICE.

Is your driver license or driver, State, VEHICLE REGISTRATION AND INSURANCE, ___ Do you own a motor vehicle, ___ Do you own a motor vehicle, Responsibility Act, NOTICE: The information on this, SOCIAL SECURITY NUMBER COLLECTION, and UNITED STATES SELECTIVE SERVICE in dl14a

Step 3: Choose the button "Done". Your PDF file is available to be exported. You may download it to your laptop or email it.

Step 4: You can create duplicates of the form tostay away from all of the potential issues. You should not worry, we cannot distribute or monitor your data.