Form Dmv 123 Vsl PDF Details

Addressing the DMV-123-VSL form, as issued by the West Virginia Department of Transportation Division of Motor Vehicles, is a crucial step for individuals deciding to voluntarily surrender their driver's license or identification card. This official document, revised in January 2011, facilitates a straightforward means for residents to relinquish their driving privileges or state-issued identification for reasons that may include medical conditions or other personal circumstances. The form requires detailed personal information, including the license or ID number and contact details. Significantly, the form outlines the need for individuals surrendering their Commercial Driver's License (CDL), Class E Driver's License, Learner's Permit, or Identification Card to understand the implications. These include mandatory re-examination and reissuance fees should the individual decide to reapply for their license in the future. Notably, the document also addresses specific conditions related to CDL holders undergoing temporary downgrades, individuals under 18, and those surrendering licenses due to medical reasons, providing clear guidance on the subsequent steps and requirements needed to reinstate driving privileges. This ensures a well-informed process for each applicant, highlighting the DMV's commitment to public safety and compliance with state regulations.

QuestionAnswer
Form NameForm Dmv 123 Vsl
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesDMV 123 VSL_Voluntary Surrender Letter WF wv voluntarily surrender letter cdl form

Form Preview Example

DMV-123-VSL

REV 1/11

West Virginia Department of Transportation

Division of Motor Vehicles

Voluntary Surrender Letter

1-800-642-9066 • www.dmv.wv.gov

NAME

 

 

 

WV LICENSE/ID NUMBER

 

 

 

 

 

 

 

STREET ADDRESS

 

 

 

OUT OF STATE LICENSE/ID NUMBER (IF APPLICABLE)

 

 

 

(

)

 

 

 

 

 

 

 

CITY

STATE

ZIP

 

PHONE NUMBER

I hereby surrender my:

Commercial Driver’s License

Class E Driver’s License

Learner’s Permit

Identiication Card

Endorsement

My reason for surrender is:

Medical

Other

•Once you have surrendered your license you will be subject to re-examination, should you choose to re-apply.

•I understand that I must retest for both knowledge and skills testing and repay all fees to be reissued a Driver’s License or CDL after the date signed below.

•If an applicant that temporarily downgrades from a CDL to a Driver’s License, wants to renew during a time when the customer is unable to obtain a DOT physical due to a medical condition, a letter is required from a physician. A customer will have a two

year period to acquire a valid DOT physical and upgrade back to a CDL license. If it takes longer than two years, retesting is required.

•If I am under the age of 18, I will fall under the Graduated Driver’s License requirements and must have parental consent before I can obtain my driving privileges.

•If I surrender my license due to medical reasons, I will be required to provide a medical report from my physician prior to any re-examination. The Division will review the medical information prior to re-examination.

•If I obtain a WV Identification Card, I understand my driving privileges will be canceled and I must retest. An applicant that has obtained an identification card while their driver’s license was suspended or revoked will be able to re-submit for a new driver’s license, if re-instated within six months of obtaining the identification card.

(X)

/

/

CUSTOMER’S SIGNATURE

 

 

DATE

 

(X)

/

/

 

GUARDIAN’S SIGNATURE (MUST SIGN IF CUSTOMER IS UNDER AGE 18)

 

 

DATE

 

Submit this form, along with your current driver’s license or ID to your local Division of Motor Vehicles or Mail to:

WV Division of Motor Vehicles

ATTN: Driver’s License Unit

PO BOX 17010

Charleston, WV 25317

EMPLOYEE’S NAME

/ /

LOCATION

DATE

 

 

 

 

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2. When the first part is filled out, go on to type in the relevant details in all these: I wish to renew my CDL but due to, My CDL will be temporarily, I will have a two year window in, I must provide a new MEC valid, Once these requirements have been, I permanently surrender my CDL for, I surrender my Graduated Drivers, I surrender my Drivers License, Other, X CUSTOMERS SIGNATURE, DATE, EMPLOYEES NAME, LOCATION, and DATE.

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