Form R 229 PDF Details

The R-229 Form serves as a comprehensive application for a non-commercial learner permit and/or driver license in the state of Connecticut, under the jurisdiction of the Department of Motor Vehicles (DMV). This document, revised in February 2021, is an essential step for residents who wish to obtain legal permission to drive. It encapsulates several critical elements ranging from the basic identification details of the applicant, including name, gender, date of birth, and physical characteristics, to more specific requirements such as proof of Connecticut residency, parental consent for applicants aged 16 and 17, and the applicant's decision on becoming an organ/tissue donor. Furthermore, it delves into the applicant's driving history, querying about past failures in driving examinations, ownership of permits or licenses from Connecticut or other states, and the status of their driving privileges. The form also touches on the responsibility of individuals of certain ages to consent to registration with the Selective Service System, if applicable. Completion of the form requires meticulous attention to providing accurate identification documents and adhering to the state's legal statutes, reflecting a commitment to road safety and legal compliance. The R-229 form thus stands as a crucial gateway for Connecticut residents looking to navigate the journey towards becoming competent, licensed drivers.

QuestionAnswer
Form NameForm R 229
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesct dmv r229, dmv driver r, dmv form r 229a, application r229

Form Preview Example

If yes, you are agreeing to be a donor and the designation will be on your license.

DMV USE

ONLY

NEW

OUT OF STATE TRANSFER

RETEST

CHANGE ENDORSEMENT/ RESTRICTION

EXCHANGE

APPLICATION FOR A NON-COMMERCIAL LEARNER PERMIT AND/OR DRIVER LICENSE R-229 REV. 2-2021

STATE OF CONNECTICUT

DEPARTMENT OF MOTOR VEHICLES

On The Web At ct.gov/dmv

INSTRUCTIONS: Complete 1-16, then present

1.Required Identification Documents & Proof of Connecticut Residency: see "Acceptable Forms of ID" at ct.gov/dmv

2.16 and 17 year olds: Certificate of Parental Consent Form 2D (if not accompanied by authorized individual)

3.Applicable Fees

LEARNER PERMIT NUMBER

DATE OF ISSUE

1.APPLICANT'S NAME (Last, First, Middle, Suffix)

2.GENDER

M

F

X

3. DATE OF BIRTH

4. HEIGHT

ft. in.

5. COLOR OF EYES

6.MAILING ADDRESS (No., Street, City or Town, State, Zip Code)

7. RESIDENCE ADDRESS (If different)

8.US CITIZEN?

Yes

No

If "NO", list ALIEN REGISTRATION NO.

9.CONNECTICUT RESIDENT?

Yes No

10. DO YOU WANT TO BE IN THE ORGAN/TISSUE DONOR REGISTRY?

Yes No

DAYTIME PHONE NO.

( )

11. SOCIAL SECURITY NUMBER

12. LIST ANY OTHER NAMES EVER USED (Alias, Maiden, etc)

 

 

 

 

 

QUESTIONS

 

 

YES (

) NO ( )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. Have you previously failed a driver's license

 

 

 

 

 

 

 

 

FAILED

 

 

 

 

 

 

 

 

 

 

 

 

LOCATION/DATE

 

 

 

 

 

 

 

 

 

 

 

KNOWLEDGE

VISION

ROAD SKILLS

 

 

 

 

 

 

 

 

 

 

examination in Connecticut?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. Do you now, or have you ever held a Connecticut Learner Permit,

 

 

 

 

 

 

 

IF YES, IN WHAT YEAR(S)?

 

 

 

CONNECTICUT PERMIT, LICENSE OR ID NO. (9 digits)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

License or Non-Driver Identification card?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. Do you now hold or have you ever held an operator's license or

 

 

 

 

 

 

 

 

STATE, DRIVER LICENSE OR ID. NO.

 

 

 

 

 

 

 

 

 

 

 

NO. OF YEARS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

identification card from another state?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. Is your privilege to operate a motor vehicle suspended or subject to

 

 

 

IN WHAT STATE(S)?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

suspension in Connecticut or in any other state?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 14-36l of the Connecticut General Statutes requires the Commissioner to transmit my

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SELECTIVE

information to the Selective Service System. By signing and submitting this application, I consent

 

MEDICAL

 

 

I hereby certify that I do not

 

 

SERVICE

to be registered with the Selective Service System, provided I am at least age 16 but under age

 

 

 

have any health or vision

 

 

26 and meet the criteria for registration in accordance with the Military Selective Service Act. If I

CERTIFICATION

 

 

problems or conditions that

 

 

CONSENT

 

 

 

 

am under age 18, I understand that my information will be transmitted to Selective Service but I

 

 

 

 

 

 

 

 

 

prevent me from driving safely.

 

 

 

will not be registered until I reach age 18.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The information provided to the Commissioner of Motor Vehicles herein is

 

SIGNATURE OF APPLICANT

 

 

DATE SIGNED

 

 

CERTIFICATION

subscribed by me, under penalty of false statement, in accordance with

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the provisions of Section 14-110 and 53a-157b of the Connecticut General

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BY APPLICANT

Statutes. I understand that if I make a statement which I do not believe to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

be true, with the intent to mislead the Commissioner, I will be subject to

 

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

prosecution under the above-cited laws.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DO NOT WRITE BELOW THIS LINE - OFFICE USE ONLY

 

 

 

 

 

 

 

 

 

 

 

PROOF OF

TYPE OF ACCEPTABLE I.D. SHOWN

 

 

 

 

 

 

 

 

 

 

 

I.D. SCANNED FIRST VISIT

 

EXAMINER INITIAL

 

 

 

STAMP NO.

 

 

IDENTIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FULL LEGAL

If different than entered in name section above (# 1)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PARENTAL

I hereby request that a learner's permit

RELATIONSHIP TO MINOR

 

 

SIGNED (Authorized Consenter)

 

 

 

 

 

CONSENTER'S LIC. NO. OR OTHER I.D.

 

 

CONSENT

and/or license be issued to the minor

 

 

 

 

 

 

 

 

 

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGE 16 OR 17 ONLY

filing this application.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VISION

VISUAL AID USED

 

 

 

 

 

 

 

 

 

 

 

 

RESULTS

 

 

 

 

AGENTS INITIALS

 

PUNCH NO. AND PUNCH

 

 

 

SCREENING

NONE

 

 

GLASSES/CONTACTS

 

 

 

 

PASSED

FAILED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RESULTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

KNOWLEDGE

 

 

 

 

 

 

 

 

TEST RESULTS

 

 

 

 

 

 

 

IDENTIFICATION DOCUMENTS

APPLICANT INITIALS

 

 

TEST

COMPUTER

 

WRITTEN

ORAL

 

 

 

WAIVED

 

PASSED

FAILED

RETURNED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERMIT

ISSUE LEARNER PERMIT

ISSUE MOTORCYCLE PERMIT

 

ISSUE PERMIT WITH CORRECTIVE LENSES

 

 

 

(B-RESTRICTION)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGENT

I hereby certify that I have examined the applicant's identity

 

SIGNED (Agent)

 

 

 

 

 

 

 

PUNCH NO. AND PUNCH

 

 

DATE SIGNED

 

 

CERTIFICATION

documents and the test results stated herein are true and

 

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

correct.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLASSROOM

 

SCHOOL NAME

 

 

 

 

 

 

 

 

COMMERCIAL SCHOOL LICENSE NO.

 

 

 

 

DRIVER EDUCATION CERTIFICATE NO.

 

 

DRIVER

INSTRUCTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRAINING

PRACTICE

 

SCHOOL NAME (If same as above print "same")

COMMERCIAL SCHOOL LICENSE NO.

 

 

 

 

DRIVER EDUCATION CERTIFICATE NO.

 

 

 

DRIVING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I hereby subscribe and certify under penalty of false statement, in accordance with the provisions of Section 14-110 and 53a-157b of the Connecticut General Statutes that I

 

 

HOME

understand that if I make a statement, which I do not believe to be true, with the intent to mislead the Commissioner I will be subject to prosecution under the above-cited laws, that,

 

 

I am qualified under Section 14-36, of the Connecticut General Statutes, over 20 years of age, have no suspensions within the previous 4 years and the Applicant has received the

 

 

TRAINING/

required training, including the equivalent of 22 hours classroom training; 40 hours on-the-road instruction; the 8 hours Safe Driver course, including a 2 hour Parent Training, as

 

 

supported by a parent log and/or driving school certificate.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMERCIAL

1

2

 

 

3

 

 

 

SIGNATURE OF INSTRUCTOR (Home Training/Commercial)

 

OPERATOR LICENSE NUMBER OR

 

 

TRAINING

Home Training

Comm/Sec and Home

 

Comm/Sec Only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SCHOOL LICENSE NUMBER

 

 

CERTIFICATION

22 hr class equiv

 

30 hrs class/minimum

 

30 hrs class

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

40 hr on-the-road

8 hr safe driving plus home

40 hrs on-the-road

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8 hr safe driving

training 40 hrs on-the-road

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ROAD TEST

WAIVED

 

PASSED

 

FAILED

 

 

NO FEE

U.S.

 

 

SPECIAL EQUIPMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AND LICENSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SERVICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NON-COMMERCIAL CLASS

ENDORSEMENT

RESTRICTIONS (Circle All Applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

 

 

M Q

 

 

B C D E F G R U

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGENT

I hereby certify that I have verified the applicant's

SIGNED (Agent)

 

 

 

 

 

 

 

PUNCH NO. AND PUNCH

 

 

DATE SIGNED

 

 

CERTIFICATION

identity and the test results stated herein are true

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and correct.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISTRIBUTION: White - Branch Office

Canary - Agent

Pink - Examiner

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