Dmv 128 Form PDF Details

In order to apply for a driver's license in the state of California, you will need to complete the DMV 128 Form. This form is used to collect information about your driving history and criminal record. In order to complete the form, you will need to provide your Social Security number and date of birth. You will also need to provide information about your current driver's license and vehicle registration. Be sure to carefully review the instructions before completing the form.

QuestionAnswer
Form NameDmv 128 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdmv128 nevada dmv declaration of homelessness form

Form Preview Example

Field Services Division

Reno/Sparks/Carson City (775) 684-4DMV (4368)

Las Vegas Area (702) 486-4DMV (4368)

Rural Nevada (877) 368-7828

Fax: (775) 684-4992

Website: www.dmvnv.com

DECLARATION OF HOMELESS STATUS

I hereby certify that I am homeless and qualify for the waiver of fees for a duplicate driver’s license,

instruction permit or identification card as prescribed in Nevada Revised Statutes Chapter 483.

I understand that the fees will be waived one time only and that I must reimburse the Department the

cost of the photo fee when I renew my card, if I am employed at the time.

I am requesting a duplicate

Driver’s License

Identification Card

Instruction Permit

Applicant’s Printed Name ___________________________________________________________

Driver’s License/Identification Card Number (if known) _____________________________________

Social Security Number _____________________________________________________________

Date of Birth ______________________________________________________________________

Address where I am staying __________________________________________________________

City _____________________________________________ State _________ Zip______________

(Effective 7/1/2010) If you are a male at least 18 and less than 26 years of age, would you like to register with the Selective Service? By registering, you will remain eligible for federal student loans, grants, job training benefits, most federal jobs and, if applicable, citizenship in the United States.

Yes

No

If yes, please initial here ____________

I hereby certify under penalty of perjury that all statements in this application are true and correct. I agree and understand that any misstatement of material facts may cause cancellation and/or denial of my driver’s license, instruction permit or identification card under NRS 483.420 and 483.530. I further understand that any misstatement of facts may be a misdemeanor or felony under NRS 483.530 and may be punishable pursuant to NRS 193.130.

Signature of Applicant _______________________________________________________

Date:_____________________________________________________________________

DMV Representative ________________________________________________________

Date:_____________________________________________________________________

DMV-128 (Rev. 7/2010)

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Step no. 1 in submitting Dmv 128 Form

2. When this section is filled out, go to type in the applicable details in all these - I am requesting a duplicate, Signature of Applicant, Date, DMV Representative, and Date.

I am requesting a duplicate, Signature of Applicant, and Date of Dmv 128 Form

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