Dl 80 Cd Form PDF Details

CDs and DVDs are gradually becoming obsolete, as more and more people switch to digital formats for music and videos. However, there are still many cases where it is preferable or necessary to use physical discs. In these situations, it is important to have the right tools to handle them.DVD and CD form DL 80 is a special type of paper that is designed for printing on CD or DVD labels. If you need to create your own discs, it is worth investing in this paper to ensure a high quality finished product.

QuestionAnswer
Form NameDl 80 Cd Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdl 80cd, dl 80, pa dl 80cd, dl80cd

Form Preview Example

DL-80CD (8-19)

COMMERCIAL DRIVER’S LICENSE APPLICATION

 

TO DUPLICATE/CORRECT

 

Federal Regulation requires CDL holders to provide in person proof of

 

citizenship or Legal Presence. For more information please see back of form.

Bureau of Driver Licensing • P.O. Box 68272 • Harrisburg, PA 17109-8272

 

A

PLEASE READ IMPORTANT INFORMATION ON THE BACK. YOU MUST COMPLETE ALL PARTS OF SECTION A.

Driver's License Number

LAST NAME

JR/ETC.

FIRST NAME

MIDDLE NAME

 

DATE OF BIRTH

TELEPHONE NUMBER (8:00 A.M.-4:30 P.M.)

E-MAIL ADDRESS

 

 

 

 

 

 

Month

 

Day

Year

 

 

 

 

 

 

 

 

BAPPLICATION FOR DUPLICATE (Check One)

 

 

CDL Learner’s Permit and/or Knowledge Test Authorization

DUPLICATE REQUIRED DUE TO:

ORGAN DONOR DESIGNATION

 

 

 

 

 

 

Lost

 

Stolen

Pennsylvania strongly supports organ and

 

 

CDL Camera Card (If checked, form MUST BE NOTARIZED)

 

 

Mutilated

 

Change of Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

tissue donation because of its life-saving

 

 

 

 

 

 

 

CDL Photo License

 

 

Correction

 

 

and life-enhancing opportunities.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School Bus Driver Endorsement Card

 

 

Other _______________________________

 

 

ADD

 

REMOVE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Never Received (MUST BE NOTARIZED - NO FEE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CCHANGE OR CORRECTION ONLY (Important information on reverse side)

ADDRESS CHANGE - Proof of Address must be provided, see reverse side. A Post Office Box number may be used in addition to the actual residence address, but cannot be used as the only address. See reverse if using an out-of-state address.

STREET ADDRESS

CITY

STATE PA

ZIP CODE

If you are a registered voter in PA, would you like us to notify your county voter registration office of this change?

 

 

 

 

YES

 

NO

 

 

 

 

 

If you are not a registered voter, you may contact your county voter registration office.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME CHANGE (Please note all name changes must be done in person with original documents)

REASON:

 

 

MARRIAGE

 

 

DIVORCE

 

 

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(see reverse side)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAST NAME

 

 

 

 

 

 

JR., ETC.

FIRST NAME

 

 

 

 

 

 

 

 

 

MIDDLE NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER CHANGES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EYE COLOR (Please check one):

 

BLUE

 

BROWN

 

GREEN

 

 

HAZEL

 

PINK

 

BLACK

 

 

GRAY

 

DICHROMATIC

 

OTHER______________________

 

 

 

 

 

 

 

 

 

 

 

ADD LENS RESTRICTION OR

REMOVE LENS RESTRICTION - (Please Note: Must include DL-102 Application completed by Health Care Provider)

 

CORRECTION OF DATE OF BIRTH

 

HEIGHT

 

 

 

 

DROP PRIVILEGE:

MONTH

 

DAY

 

YEAR

FEET

 

INCHES

 

 

Class M

 

 

Hazmat Endorsement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

No person may hold more than one valid license at any time. If you have a license from another state, do not use this form. YOU MUST go to a Driver License Examination Center to surrender your out-of-state license and make application for a replacement PA license.

ALL MUST BE ANSWERED

1.o YES o NO - Is your driver's license or driving privilege suspended or revoked in this state or any other state?

2.o YES o NO - Do you have any pending criminal charges or driving violations in this state or any other state which may carry a possible penalty of suspension or revocation of your driver’s license or driving privilege?

If yes, give state_____________ Date ______________ and Reason ______________________________________________

E

AUTHORIZATION AND CERTIFICATION

THIS SECTION MUST BE NOTARIZED

 

 

 

 

 

 

 

 

 

For Veterans wishing to add the Veterans Designation to their Driver’s License or ID Card:

AFFADAVIT: This section must be notarized when applying for replacement (duplicate)

 

 

 

 

I certify under penalty of law that I am a qualified applicant and hereby request it be added to myproduct.

 

 

Commercial License or Camera Card. You are entitled to a free replacement ONLY if

 

 

I understand that misrepresentation will result in the cancellation of my driver’s license.

 

 

this application is completed within 90 days of the original date of issuance and the

 

I acknowledge that receiving a Pennsylvania Permit, License or ID card will cancel or invalidate any Permit,

 

original was never received due of loss in the mail.

 

 

 

License or ID card from another state. I certify under penalty of law that all information given on this application is

 

 

 

 

 

 

 

 

true and correct. I hereby authorize the Social Security Administration to release to the Department of Transportation

 

 

 

 

 

 

 

 

 

information concerning my Social Security Identification Number for the purpose of identification. If using a Messenger

SUBSCRIBED AND SWORN

 

 

 

Service, I hereby authorize the Department to furnish them with my driving record for the purpose of processing

TO BEFORE ME:

MO

DAY

YEAR

 

this form. I hereby acknowledge this day that I have received notice of the provisions of Section 3709 of the Vehicle

 

 

 

 

 

 

 

 

 

Code. (See reverse for provisions.)

 

Signature of Person Administering Oath

 

I wish to contribute $3.00 to the Organ Donation Awareness Trust Fund. (see reverse)

 

 

I wish to contribute $3.00 to the Veterans’ Trust Fund. (see reverse)

 

is a misdemeanor of the third

 

 

 

 

 

 

 

 

 

WARNING: Misstatement of fact

S

 

 

 

 

 

 

 

 

degree punishable of up to

 

 

SIGN

 

 

 

 

$2,500and/or imprisonment up

E

 

XHERE

 

 

 

 

to 1 year (18 Pa C.S. Section

SIGN IN PRESENCE OF NOTARY

 

 

APPLICANT’S SIGNATURE IN INK

 

(DATE)

 

4904(b)).

A

 

 

 

 

 

 

PAID BY:

Debit/Credit Card

Check

Money Order

TOTAL $

L

 

Payable to PennDOT (PennDOT Driver License Centers do not accept cash.)

 

 

 

 

 

 

 

 

 

 

 

 

DL-80CD (8-19)

OUT-OF-STATE ADDRESS CHANGE. We may not issue driver license products to an out-of-state address, except in the case of an employee of federal or state government, armed forces personnel, or their families, whose workplace is located outside of Pennsylvania. If this exception applies to you, please check the appropriate box and include documentation of your status with this application.

Attach a letter from your employer on their letterhead to document your status, or attach a copy of your current Photo ID issued by your employer. If you are the immediate family of a person meeting one of the allowable exceptions, attach the documentation of the person employed. Additionally, you must indicate your relationship to that person.

I certify that my workplace is located out of state and I am employed by, or am the immediate family of a person employed by:

US Armed Forces o Federal Government Relationship to person meeting exemption (check one):

o Pennsylvania State Government

o Spouse o Dependent Child

•Veterans Designation: You have the opportunity to add the veterans designation to your driver’s license, which clearly indicates you are a veteran of the United States

Armed Forces. To qualify, you must have served in the United States Armed Forces, including a reserve component or the National Guard, and have been discharged or released from such service under conditions other than dishonorable. If you are requesting to add the veterans designation to your license, make sure you check the box at the top in Section E.

•Return your completed and signed application with your check or money order made payable to “PennDOT”, to: Bureau of Driver Licensing, P.O. Box 68272,

Harrisburg, PA 17106-8272.

•If your license is due to expire within six (6) months, complete form DL-143CD (Renewal of a Commercial Driver’s License).

•If you find or recover your original license after you have submitted this application for a duplicate, return the original license with a letter of explanation to: Bureau of

Driver Licensing, PO Box 68615, Harrisburg, PA 17106-8615. After the duplicate is issued, the original license is no longer valid.

 

DUPLICATE FEE SCHEDULE

 

 

NEVER RECEIVED

Application for a duplicate camera card or a product never received, the form must be notarized. Fees will apply if more than 90

 

days from date issued.

LEARNER’S PERMIT AND/OR

FEE $5.00 NOTE: Permit expiration date will remain the same. If your Learners Permit expires within 15 days, you will

KNOWLEDGE TEST

be required to purchase an extension using a DL-31CD. NOTE: If extending or upgrading your permit, you must surrender

AUTHORIZATION

your existing permit.

 

 

CDL CAMERA CARD

FEE: $5.00 if photo was not taken with the original camera card and this form must be notarized.

IF LICENSE IS ENDORSED WITH A CLASS M, THE FEE IS $11.00 and this form must be notarized.

 

 

 

 

FEE: $30.50 - The Bureau will issue one of the following: (this form must be notarized.)

CDL

• A camera card, which is a temporary Commercial Driver’s License for 60 days, for the purpose of having a

PHOTO LICENSE

photo-image taken at a Photo Driver’s License Center

• A Commercial Driver’s License, complete with the applicant’s most recent photo-image

 

 

IF LICENSE IS ENDORSED WITH CLASS M, THE FEE IS $35.50 and this form must be notarized.

 

 

SCHOOL BUS ENDORSEMENT

NO FEE

 

 

ORGAN DONATION

When you are adding or removing the Organ Donor designation a duplicate fee is required. Refer to fees above.

DESIGNATION

 

 

 

ORGAN DONATION

You have the opportunity to contribute $3.00 to the Fund. The additional $3.00 contribution must be added to your payment.

You must also check the block provided to ensure proper handling of your contribution. The ODTF provides for the

AWARENESS TRUST

development and implementation of donor awareness programs and funds shall be appropriated subject to the approval of

FUND (ODTF)

the Governor.

 

 

 

VETERANS’ TRUST

You have the opportunity to make a tax deductible contribution to the VTF. Your contribution will help support programs and

projects for Pennsylvania veterans and their families. Since this additional $3.00 is not part of the fee, please add the donated

FUND (VTF)

amount to your payment. Also, please check the proper block on the form to ensure your contribution is handled properly.

 

 

 

NAME CHANGE - If you desire to use your birth name, you must present your state issued birth certificate with a raised seal. If your name changed by permission of court, you must present a Certified Copy of the Court Order. If you desire to use your spouse’s surname, you must present your marriage certificate. If you desire to use another name, you must present your Social Security Card, together with two other sources issued in the desired name such as: Tax Records, Selective Service Card, Voter Registration Card, Passport, any form of Photo I.D. issued by a governmental agency, banking records, or baptismal certificate.

To report errors on your driver’s license relating to name, date of birth or social security number, please contact PennDOT’s Customer Care Center at 717-412-5300.

If you are required to present supporting documentation to correct your record, all documents must be originals and presented in person at a PennDOT Driver License Center.

•For NAME corrections, you must present your state issued birth certificate with a raised seal, a Certified Copy of the Court Order or your marriage certificate.

•For DATE OF BIRTH corrections, you must present state issued birth certificate with raised seal.

•For SOCIAL SECURITY NUMBER corrections, you must present your Social Security Card.

*Note: All name changes must be made in person at a Driver License Center. All documents must be original.

CHANGE OF ADDRESS - FEDERAL REGULATIONS HAVE CHANGED: All CDL holders must prove U.S. Citizenship or legal presence and residency. If you are requesting a change of address you must provide one of the following residency documents. To determine if you must appear in person please contact our customer call center at 717-412-5300.

TO MEET RESIDENCY REQUIREMENTS YOU MUST PRESENT ONE OF THE FOLLOWING

• Tax Records

• Lease Agreements

• Mortgage Documents

• W-2 Form (do not mail)

• Current Weapons Permit (U.S. Citizen only)

• Current Utility Bills (water, gas, electric, cable, etc.)

--The proof of residency documents must have your name and official Pennsylvania street address on it.--

ALL DOCUMENTS PRESENTED AT A DRIVER LICENSE CENTER MUST BE ORIGINAL.

PROVISIONS OF SECTION 3709 OF THE VEHICLE CODE

Section 3709 provides for a fine of up to $300 for dropping, throwing or depositing, upon any highway, or upon any other public or private property without the consent of

the owner thereof or into or on the waters of this Commonwealth, from a vehicle, any waste paper, sweepings, ashes, household waste, glass, metal, refuse or rubbish or any dangerous or detrimental substance, or permitting any of the preceding without immediately removing such items or causing their removal. For any violation of

Section 3709, I may be subject to a fine of up to $300 upon conviction, including any violation resulting from the conduct of any other persons present within any vehicle

of which I am the driver.

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With regards to the blank fields of this particular form, this is what you should consider:

1. The dl 80 will require specific information to be inserted. Be sure the subsequent fields are finalized:

Writing part 1 of form dl 80

2. The next part would be to fill out these particular fields: NAME CHANGE Please note all name, MARRIAGE DIVORCE, OTHER see reverse side, LAST NAME, JR ETC, FIRST NAME, MIDDLE NAME, OTHER CHANGES EYE COLOR Please, BLUE BROWN GREEN HAZEL PINK BLACK, ADD LENS RESTRICTION OR REMOVE, CORRECTION OF DATE OF BIRTH, HEIGHT, DROP PRIVILEGE, MONTH, and DAY.

Completing segment 2 of form dl 80

Always be really careful when filling in NAME CHANGE Please note all name and MIDDLE NAME, because this is where many people make some mistakes.

3. Through this stage, check out I wish to contribute to the Organ, XSIGN, HERE, APPLICANTS SIGNATURE IN INK, DATE, WARNING Misstatement of fact is a, PAID BY DebitCredit Card Check, Payable to PennDOT PennDOT Driver, TOTAL, S E A L, and SIGN IN PRESENCE OF NOTARY. All these will need to be taken care of with highest precision.

Completing part 3 of form dl 80

4. The form's fourth paragraph comes with these particular blank fields to enter your details in: OUTOFSTATE ADDRESS CHANGE We may, US Armed Forces o Federal, Relationship to person meeting, Veterans Designation You have the, DUPLICATE FEE SCHEDULE, NEVER RECEIVED, Application for a duplicate camera, LEARNERS PERMIT ANDOR, KNOWLEDGE TEST, AUTHORIZATION, FEE NOTE Permit expiration date, CDL CAMERA CARD, FEE if photo was not taken with, FEE The Bureau will issue one of, and A camera card which is a.

The best ways to prepare form dl 80 step 4

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