Dl82 Form – Fill Out and Use This PDF

DL-82(2-14)

OUT-OF-STATE ADDRESS/

PHOTO EXEMPTION

Bureau of Driver Licensing • P.O. Box 68272 • Harrisburg, PA 17106-8272

Attach a letter from your employer on their letterhead to document your status, or a copy of your current Photo ID issued by your employer, or military personnel must provide a copy of military orders. 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.

A DRIVER INFORMATION

Type or Print All Information

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-MAILADDRESS (If Applicable)

MONTH

DAY

YEAR

Residential

A Post Office Box number may be used in addition to the actual residence address, but cannot be used as the only address.

Address

Mailing

Address

BCOMPLETE IF REQUESTING RESIDENCY EXEMPTION

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:

O U.S. Armed Forces O Federal Government O Pennsylvania State Government Relationship to person meeting exemption (check one): O Spouse O Dependent Child

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.

CCOMPLETE IF REQUESTING EXEMPTION FROM HAVING YOUR PHOTO TAKEN

If you are a non-commercial driver and will be out of state for the entire next 60 days, complete and sign the following statement and submit with a completed DL-143application. You will receive either a Camera Card with further instructions or a photo license (if name has not changed and a photo is on file). You must apply for a driver's license containing your photo within 45 days of your return.

STATEMENT:

I am a non-commercial driver and during the entire next 60 days I will be absent from the state for the following reason:

O Military O Work O Other __________________________ (attach supporting documentation)

NOTE: If you have already renewed your driver’s license and received a photo camera card, you may request a free replacement photo exempt license by attaching the original signed photo camera card you recently received to this application. Otherwise, you have to apply for a duplicate using form DL-80 along with the required fee.

DAUTHORIZATION AND CERTIFICATION

I certify under penalty of law that all information given on this application is true and correct. If using a Messenger Service, I hereby authorize the Department to furnish them with my driving record for the purpose of processing this form. I hereby acknowledge this day that I have received notice of the provisions of Section 3709 of the Vehicle Code.

X
SIGN	WARNING: Misstatement of fact is a misdemeanor of the
HERE	third degree punishable by a fine of up to $2,500 and/or
	imprisonment up to 1 year (18 Pa C.S. Section 4904(b).

(APPLICANT’S SIGNATURE IN INK)

Please mail this completed form with any required document(s) to the address at the top right corner of this form.

The most current version of this form can be found at: www.dmv.state.pa.us