Form Dl 54A – Fill Out and Use This PDF

The DL-54A form, officially known as the Application for Initial Identification Card, is a crucial document managed by the Bureau of Driver Licensing in Pennsylvania. It is designed for individuals who are applying for a non-driver identification card for the first time or converting their driver's license to an ID card for various reasons, including health-related issues that affect driving abilities. All sections of the form must be completed, and it includes personal information such as name, date of birth, social security or driver's license number, and desired gender designation, among others. If you need to apply for or renew your Pennsylvania ID card, click the button below to learn more about how to fill out the DL-54A form.

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Form Dl 54A PDF Details

In the realm of official documentation and identity verification within Pennsylvania, the DL-54A form stands out as a critical piece, especially for individuals seeking to obtain their initial identification card. This comprehensive application, facilitated by the Bureau of Driver Licensing, serves multiple purposes—from new applications to changes in gender designation, and even organ donor indications. The form, carefully structured, mandates the fill-out of personal details such as name, Social Security or driver's license number, and contact information, while also accommodating a section for those transitioning in their gender identity, underlining Pennsylvania's recognition and support for diversity. Furthermore, the DL-54A addresses situations like change of address and encapsulates various scenarios wherein one could be applying for an identification card—be it due to health reasons affecting driving ability, voluntary surrender of driving privileges, or as an addition alongside a current or expired driver's license. Notably, it extends the thoughtful gesture of allowing veterans to add a designation to their ID, highlighting their service. This document not only aids in the logistical aspect of identification but also embraces aspects of social responsibility and inclusivity, further underscored by the option to contribute towards organ donation and veterans' trust funds, underscoring a collective ethos towards community support and acknowledgment of service members.

Question	Answer
Form Name	Form Dl 54A
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	pa application identification card, pennsylvania identification card, pennsylvania dl application, form application identification form

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DL-54A (7-21)

APPLICATION FOR INITIAL IDENTIFICATION CARD

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

ALL SECTIONS MUST BE COMPLETED

LAST NAME

JR./ETC

FIRST NAME

MIDDLE NAME

DATE OF BIRTH

HEIGHT

SOCIAL SECURITY NUMBER OR DRIVER'S LICENSE NUMBER

Telephone Number (8:00 a.m. to 4:30 p.m.)

MONTH

DAY

YEAR

FEET

INCHES

EYE COLOR (please check one):

BLUE

BROWN

GREEN

HAZEL

PINK

BLACK

GRAY

DICHROMATIC

OTHER ________________________________

SEX/GENDER DESIGNATION

wish the gender designation on my Driver’s License/ ID Card to read

PRINT NAME

Male (M)

Female (F)

Non-Binary/Other (X)

I hereby certify under penalty of law that this request for the selected gender designation to appear on my Driver’s License/ ID Card accurately reflects my gender identity and is not for any fraudulent

or other unlawful purpose.

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

CITY

STATE PA

ZIP CODE

If this is a change of address and you are a registered voter in PA, would you like us to

YES

If you are not a registered voter, you may

notify your county voter registration office of this change?

contact your county voter registration office.

ADD (Parental consent required if under 18)

REMOVE

PA strongly supports organ and tissue donation because of its life-saving and life-enhancing opportunities

Do you hold a current/valid out-of-state driver's license?

YES

If yes, you must surrender your out-of-state valid license.

Please provide the names and record

STATE

LP/DL/ID NUMBER

NAME (if different than above)

numbers (if known) of all States where you have

______

__________________________

____________________________________________________________________________

previously been issued a Learner Permit (LP),

______

__________________________

____________________________________________________________________________

Driver's License (DL), or Identification Card (ID).

______

__________________________

____________________________________________________________________________

CHECK APPLICABLE BLOCK BELOW:

FEE INFO.

(You must apply in person at any Driver License Center.)

$32.50

I HAVE NEVER HELD A PA DRIVER'S LICENSE/PERMIT OR IDENTIFICATION CARD AND I AM APPLYING FOR AN INITIAL IDENTIFICATION CARD.

I CURRENTLY HOLD A PA DRIVER'S LICENSE/PERMIT AND AM APPLYING FOR A NON-DRIVER IDENTIFICATION CARD FOR THE FOLLOWING REASON:

I am surrendering my driving privilege for health reasons that may affect my ability to safely operate a motor vehicle. I understand that my license will not be

FREE

reissued until I successfully complete the appropriate examination. (If you have not already surrendered your Driver's License/ Learner's Permit,

please attach it to this application.)

I am voluntarily surrendering my driving privilege with the understanding that it will be retained for a minimum of six months as required by 67 Pa. Code 93.2.

$32.50

It is understood that I will not be permitted to apply for my driver's license, Class A through M inclusive, for a period of six months. (Attach Driver's License/ Learner's

Permit.) A VOLUNTARY SURRENDER WILL NOT BE ACCEPTED TOWARD A SUSPENSION, RECALL, CANCELLATION, OR REVOCATION.

As a result of my parent's or guardian's withdrawal of consent for me to drive a motor vehicle (Attach Driver's License/Learner's Permit.)

$32.50

PLEASE NOTE: A DL-100A MUST ACCOMPANY THIS APPLICATION.

As a result of the suspension of my driver's license. License MUST be attached. If not, you MUST complete the ACKNOWLEDGEMENT:

I ___________________________________ hereby acknowledge that my driving privilege is suspended/revoked/disqualified in Pennsylvania and my

(PRINT NAME)

License issued by Pennsylvania has expired.

License issued by Pennsylvania has been:

Lost

Stolen

Mutilated

$32.50

When?______________________

How?

___________________________________________________________________________________________________

License issued by Pennsylvania has been surrendered to or confiscated by the Police/Court.

When?______________________

What Police Department/County?__________________________________________________________________________

License issued by Pennsylvania has been previously surrendered to PennDOT to serve an existing period of suspension.

When?______________________

Why were you suspended?________________________________________________________________________________

I DESIRE TO HAVE AN IDENTIFICATION CARD ALONG WITH MY CURRENT/EXPIRED PA DRIVER'S LICENSE/PERMIT.

$32.50

CERTIFICATION (SIGN AND ENTER DATE OF APPLICATION)

REQUEST FOR ORGAN DONOR DESIGNATION

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

PARENTAL CONSENT

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

I am under the age of 18 years and I hereby request Organ Donor

product. I understand that misrepresentation will result in the cancellation of my identification card.

designation on my Pennsylvania I.D. Card. Applicants 18 years of age

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

or older will have the opportunity to request Organ Donor designation

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

on my Pennsylvania I.D. Card.

application is true and correct. I hereby authorize the Social Security Administration to release to the

I hereby certify that I am a

Department of Transportation information concerning my Social Security Identification Number for the

Parent,

Guardian,

purpose of identification. If using a Messenger Service, I hereby authorize the Department to furnish

Person in Loco Parentis, or

Spouse at least 18 years of age and

them with my driving record for the purpose of processing this form.

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

Do give consent

Do NOT give consent for applicant's request for Organ

SIGN

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

Donor designation.

HEREX

SIGN

APPLICANT'S SIGNATURE IN INK

DATE

HEREX

WARNING: Misstatement of Fact is a misdemeanor of the third degree punishable by a fine of up to $2,500 and/or

imprisonment up to 1 year (18 Pa. C, Section 4904 [b]).

SIGNATURE OF PARENT, GUARDIAN, PERSONS IN LOCO PARENTIS, OR SPOUSE AT LEAST 18 YEARS OF AGE

DATE

PAID BY:

Debit/Credit Card

Check

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

TOTAL $

DEPARTMENTAL USE ONLY

ID NUMBER ______________________________________________

RESIDENCY REQUIREMENTS (LIST TWO) 1. ________________________________________ 2. _________________________________________

VERIFICATION OF BIRTH DATE & IDENTITY

Birth certificate

Other _________________________________________________________

SIGN

HEREX

SIGNATURE OF EXAMINER

DATE

BADGE NO.

EXAM CENTER

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Form Dl 54A – Fill Out and Use This PDF

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