Dmv Form Dl 5 PDF Details

The Department of Motor Vehicles (DMV) Form DL 5 is a document used to request a duplicate driver's license. The form can be downloaded from the DMV website or picked up at your local DMV office. There are a few things you'll need to have on hand before you start filling out the form, including your current driver's license number, social security number, and date of birth. Be sure to double-check that all the information listed is correct before submitting the form. If everything looks good, mailing it in should only take a couple of weeks for your new driver's license to arrive in the mail.

QuestionAnswer
Form NameDmv Form Dl 5
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdl5 state of virginia insurance id card fillable form

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Completion of this section is requested but not required to apply for a driver's license or ID Card. (Virginia Code §2.2-3806)

INFORMATION FOR THE VIRGINIA TRANSPLANT COUNCIL

Yes, I would like to become an organ, eye and tissue donor.

IDENTIFICATION CARD APPLICATION

FOR MINORS UNDER AGE 15

DL 5 (07/01/2021)

LOG #

Purpose: Minors under age 15 use this form to apply for an identification card.

Instruction: To qualify for an identification card for a minor, the applicant must be a Virginia resident under age 15. Print in ink or type. Virginia Code requires that you provide DMV with the information on this form (including your social security number).

APPLICATION TYPE

REAL ID: ID requirements for domestic air travel and access to secure federal facilities change May 3, 2023. A REAL ID meets these requirements.

Would you like to apply for a REAL ID identification card?

Yes - I would like to use my identification card as ID to board a domestic flight or enter a secure federal facility or military base on or after May 3, 2023. View the documents you'll need at dmvNOW.com/REALID or ask for a brochure.

No - I acknowledge my identification card will display "Federal Limits Apply" and I will need another form of ID to board a domestic flight or enter a secure federal facility or military base on or after May 3, 2023.

Original

Renewal

Replacement

If you are applying for a replacement ID Card check one of the following;

 

 

I am surrendering my current ID Card.

 

 

I certify my current ID Card is unavailable for surrender because it is:

lost stolen

destroyed/mutilated

APPLICANT INFORMATION

NOTE: YOUR ADDRESS BELOW MUST BE CURRENT. THE U.S. POSTAL SERVICE WILL NOT FORWARD ID CARDS.

FULL LEGAL NAME (last, first, middle, suffix)

 

 

 

 

 

 

SOCIAL SECURITY NUMBER (SSN)

 

I HAVE NOT BEEN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ISSUED A SSN.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTHDATE (mm/dd/yyyy)

SEX (check one)

 

 

 

WEIGHT

 

HEIGHT

 

 

EYE COLOR

 

 

HAIR COLOR

 

 

 

MALE

 

 

FEMALE

 

NON-BINARY

 

LBS.

 

 

 

 

FT.

 

IN.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

APT NO.

 

 

 

CITY

 

 

 

 

STATE ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER (optional)

IF YOUR NAME HAS CHANGED, PRINT FORMER NAME HERE

 

 

NAME OF CITY OR COUNTY OF RESIDENCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

 

COUNTY OF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS (if different from above - this address will show on your ID card)

APT NO.

 

 

 

CITY

 

 

 

STATE ZIP CODE

 

EMAIL ADDRESS (optional)

SPECIAL INDICATOR REQUEST

Please show the following indicator(s) on my ID card: (Must submit required physician statement.)

Insulin-dependent diabetic

 

Speech impairment

 

Hearing impairment

Intellectual disability (IntD)

 

Autism spectrum disorder (ASD)

 

Blind or vision impairment

 

 

Traumatic brain injury

 

 

 

 

EMERGENCY CONTACT INFORMATION

Participation in the Emergency Contact Program is voluntary. If you choose to participate, emergency contact information will be added to your identification card record. This information will only be accessible to DMV and law enforcement. Add this information on page 2 of this form.

"Certification" section on the back of this form must be completed.

FOR DMV USE ONLY — DO NOT WRITE BELOW THIS LINE

CUSTOMER NUMBER

TRANSACTION TYPE

 

ORIGINAL

 

REISSUE

 

DUPLICATE

 

RENEWAL

 

 

 

 

 

 

FEE

CSR SIGNATURE

CSR LOGON ID

DL 5 (07/01/2021) -- Page 2

CONTACT 1

CONTACT 2

EMERGENCY CONTACT INFORMATION (continued)

FIRST NAME, LAST NAME AND PRIMARY TELEPHONE NUMBER ARE REQUIRED

(Contact must be a person 18 years of age or older)

CONTACT FIRST NAME

CONTACT LAST NAME

 

 

 

 

PRIMARY TELEPHONE NUMBER

 

 

 

 

 

 

 

 

CONTACT STREET ADDRESS

CITY

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

COUNTRY

ARE YOU RELATED TO

 

YES

 

NO

SECONDARY TELEPHONE NUMBER

 

 

 

 

 

 

THE CONTACT?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRST NAME, LAST NAME AND PRIMARY TELEPHONE NUMBER ARE REQUIRED

(Contact must be a person 18 years of age or older)

CONTACT FIRST NAME

CONTACT LAST NAME

 

 

 

 

PRIMARY TELEPHONE NUMBER

 

 

 

 

 

 

 

 

CONTACT STREET ADDRESS

CITY

 

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

COUNTRY

ARE YOU RELATED TO

 

YES

 

NO

SECONDARY TELEPHONE NUMBER

 

 

 

 

 

 

THE CONTACT?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IMPORTANT INFORMATION IF PARTICIPATING IN EMERGENCY CONTACT PROGRAM

Please ensure the emergency contact information provided is up to date and accurate. Virginia DMV is not responsible for any errors in the information provided. In the event of an emergency, this contact information may be disclosed to emergency personnel. Per Virginia statute, DMV is immune from liability if the designated person(s) listed cannot be contacted.

NOTICE

Va. Code §§46.2-323 and 46.2-342 require that you provide DMV with the information on this form (including your social security number). Your personally identifiable information is being collected for record keeping purposes and will be disseminated only in accordance with Va. Code §§46.2-208, 46.2-209, 46.2-345, and the Driver’s Privacy Protection Act, 18 USC §2721. Persons convicted of certain sexual offenses (as listed in Va. Code §9.1-902) must register or re-register with the Virginia Department of State Police as provided in Va. Code §§9.1-901, 9.1-903, and 9.1-904. If you provide a non-Virginia residence/home address or non-Virginia mailing address, your application for an identification card may be denied. Upon issuance of an identification card in the Commonwealth of Virginia, any driver’s license or identification card previously issued by another state must be surrendered and will be cancelled by the issuing state.

CERTIFICATION

Parent/Legal Guardian, check the box if you give consent for this minor to become an organ, eye and tissue donor and for the Department of Motor Vehicles (DMV) to display this information on his/her identification card.

I certify and affirm that my child is a resident of Virginia, that all information presented in this application is true and correct, that any documents I have presented to DMV are genuine, and that my child's appearance, for purpose of this DMV photograph, is a true and accurate representation of how he/ she generally appears in public. I make this certification and affirmation under penalty of perjury and understand that knowingly making a false statement on this application is a criminal violation. By signing this form, I authorize DMV to verify the information provided on this application, as required to determine eligibility.

PARENT/LEGAL GUARDIAN NAME (print)

PARENT/LEGAL GUARDIAN SIGNATURE

DATE (mm/dd/yyyy)

SELECTIVE SERVICE

All males under the age of 26 are required to check one of the following. Failure to provide a response will result in denial of your application.

I am already registered with Selective Service.

I am a lawful non-immigrant on a current non-immigrant visa or a seasonal agricultural worker (H-2A Visa) and not required to register.

I authorize DMV to forward to the Selective Service System personal information necessary to register me with Selective Service.

By signing this application, I consent to be registered with Selective Service, if required by federal law. If under age 18, an appropriate adult must complete and sign below: I authorize DMV to send information to Selective Service which will be used to register applicant when he is 18 years old.

SIGNATURE (check one and sign)

PARENT / GUARDIAN

JUDGE, JUVENILE DOMESTIC RELATIONS COURT

EMANCIPATED MINOR

How to Edit Dmv Form Dl 5 Online for Free

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Step 1: Press the orange "Get Form" button above. It will open our pdf tool so you can start filling out your form.

Step 2: As soon as you open the tool, you will notice the form all set to be completed. Other than filling out different fields, you may also do various other actions with the PDF, including adding custom textual content, modifying the original textual content, inserting illustrations or photos, putting your signature on the PDF, and more.

This form needs some specific details; in order to guarantee accuracy, make sure you adhere to the tips listed below:

1. First, when completing the Dmv Form Dl 5, start in the area with the following blank fields:

Writing section 1 in Dmv Form Dl 5

2. Soon after the prior section is done, proceed to type in the relevant information in all these - MALE, FEMALE, NONBINARY, STREET ADDRESS APT NO CITY STATE, TELEPHONE NUMBER optional, IF YOUR NAME HAS CHANGED PRINT, NAME OF CITY OR COUNTY OF RESIDENCE, CITY, COUNTY OF, MAILING ADDRESS if different from, EMAIL ADDRESS optional, Please show the following, SPECIAL INDICATOR REQUEST, Insulindependent diabetic, and Intellectual disability IntD.

The best ways to prepare Dmv Form Dl 5 step 2

3. Completing DUPLICATE, and RENEWAL is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Part number 3 for submitting Dmv Form Dl 5

It's easy to make an error when completing the RENEWAL, and so make sure that you take another look prior to deciding to submit it.

4. The next section will require your input in the following places: CONTACT FIRST NAME, CONTACT LAST NAME, PRIMARY TELEPHONE NUMBER, CONTACT STREET ADDRESS, CITY, STATE, ZIP CODE, COUNTRY, ARE YOU RELATED TO THE CONTACT, YES, SECONDARY TELEPHONE NUMBER, FIRST NAME LAST NAME AND PRIMARY, Contact must be a person years of, CONTACT FIRST NAME, and CONTACT LAST NAME. It is important to fill in all requested info to go further.

Filling in section 4 in Dmv Form Dl 5

5. The form needs to be finalized by filling out this segment. Further you can find a full list of fields that need specific details to allow your form usage to be complete: ParentLegal Guardian check the box, CERTIFICATION, I certify and affirm that my child, PARENTLEGAL GUARDIAN NAME print, PARENTLEGAL GUARDIAN SIGNATURE, DATE mmddyyyy, SELECTIVE SERVICE, All males under the age of are, I am already registered with, I am a lawful nonimmigrant on a, I authorize DMV to forward to the, By signing this application I, SIGNATURE check one and sign, PARENT GUARDIAN, and JUDGE JUVENILE DOMESTIC RELATIONS.

How you can complete Dmv Form Dl 5 portion 5

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