Form Dmv 115 PDF Details

The DMV 115 form serves a vital purpose for residents of Nevada seeking to obtain a driver’s license, driver authorization card (DAC), or identification card, especially for those who may not have a traditional residential address. This form acts as a certification by a recognized relief agency or shelter, verifying that the individual applying for the identification is indeed a resident of Nevada. It is a critical piece of documentation for those who are receiving social services and might not have other means to prove their residency within the state. The form requires detailed information including the applicant's name, residence address, and, if applicable, a different mailing address. It also necessitates details about the certifying Nevada relief agency or shelter, such as the organization's name, address, and the contact person’s name and telephone number. Notably, the form highlights the role of the Social Security number in verifying the applicant's identity, pursuant to the United States Congress's Privacy Act. Furthermore, it sternly reminds applicants about the consequences of providing false information, which can lead to the denial of the application or even criminal charges. This certification thereby acts not just as a formality but as a crucial step in ensuring access to necessary identification for some of Nevada’s most vulnerable residents.

QuestionAnswer
Form NameForm Dmv 115
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdmv115 dmv 115 relief nevada form

Form Preview Example

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

Relief Agency or Shelter Certification

This certification is used to support a claim that you are a Nevada resident. You must be a resident of Nevada to be eligible for a driver’s license, driver authorization card (DAC) or identification card (NRS 483.250 (7), 483.290 (5)(b), and 483.934). The definition of “resident” is found in NRS 483.141.

This certification will be accepted as one form of evidence for your principal residence address.

Customer Information

Name

Residence Address

City

State

Zip

 

 

NV

 

Mailing Address if different

City

State

Zip

 

 

NV

 

 

 

 

 

DL/ID Number

Social Security Number (not required for a DAC)

 

 

 

 

 

 

 

 

 

Nevada Relief Agency or Shelter Information

Organization Name

Organization Address

City

State

Zip

 

 

NV

 

Contact Person Name

Telephone Number

 

 

 

 

 

 

Tax ID Number

Tax-ID Exempt □

 

 

 

 

 

 

 

 

 

I certify that the above-named individual is a resident of Nevada receiving social services from the organization named on this certification.

Nevada Relief Agency or Shelter Authorized Signature

Date

DISCLOSURE STATEMENT: The Privacy Act as passed by the United States Congress authorizes the use of your Social Security number for the purpose of verifying your identity. This number must be provided and will be used in the administration of driver license laws as required by NRS 483.290.

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 license or identification card under NRS 483.420 and NRS 483.530, respectively. 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.

Applicant Signature

Date

(DMV-115, 8/13)

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This PDF will need specific information to be entered, hence ensure that you take the time to fill in precisely what is required:

1. The Form Dmv 115 needs particular information to be entered. Be sure that the following blanks are filled out:

Stage # 1 in filling out Form Dmv 115

2. Just after completing this section, head on to the subsequent step and enter the essential particulars in all these blanks - Organization Name, Organization Address, Contact Person Name, Tax ID Number, State NV, Zip, City, Telephone Number, TaxID Exempt, Nevada Relief Agency or Shelter, I certify that the abovenamed, Date, Applicant Signature, and Date.

Stage no. 2 for completing Form Dmv 115

When it comes to Tax ID Number and Contact Person Name, be certain that you take another look in this current part. Both of these are the key ones in this PDF.

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