DL-3731 (12-21)
APPLICATION FOR IGNITION INTERLOCK
LICENSE/RETURN OF REGULAR DRIVER LICENSE
PLEASE READ IMPORTANT INFORMATION ON THE REVERSE SIDE.
AAPPLICANT INFORMATION
DRIVER'S LICENSE NUMBER |
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LAST NAME |
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JR/ETC |
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FIRST NAME |
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MIDDLE NAME |
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DATE OF BIRTH |
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TELEPHONE NUMBER (8:00 A.M.-4:30 P.M.) |
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E-MAIL ADDRESS (if applicable) |
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Day |
Year |
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EYE COLOR (Please check one): |
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BLUE |
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BROWN |
GREEN |
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HAZEL |
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PINK |
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BLACK |
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GRAY |
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DICHROMATIC |
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OTHER__________________ |
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OUT-OF-STATE ADDRESS CHANGE. We may not issue driver license products to an out-of-state address, except in the case of an employee of federal or state government, armed forces personnel, or their families, whose workplace is located outside of Pennsylvania. If this exception applies to you, please check the appropriate box and include documentation of your status with this application.
Attach a letter from your employer on their letterhead to document your status, or attach a copy of your current Photo ID issued by your employer. If you are the immediate family of a person meeting one of the allowable exceptions, attach the documentation of the person employed. Additionally, you must indicate your relationship to that person.
I certify that my workplace is located out of state and I am employed by, or am the immediate family of a person employed by:
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US Armed Forces |
Federal Government |
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Pennsylvania State Government |
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Relationship |
to person meeting exemption (check one): |
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Spouse |
Dependent Child |
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ADDRESS CHANGE - A Post Office Box number may be used in addition to the actual residence address, but cannot be used as the only address.
NEW |
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STREET |
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ADDRESS |
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CITY |
STATE |
ZIP CODE |
This application will also serve as a request to update your voter registration unless you check this box:
If you are not registered to vote, you will receive an application to register. You must be a U.S. citizen to register to vote in Pennsylvania.
Pennsylvania strongly supports organ and tissue donation because of its life-saving and life-enhancing opportunities.
ADD (Parental consent required if under 18) |
REMOVE |
BAPPLICATION OPTIONS - MUST CHECK ONE
OPTION 1 |
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I am applying for an ignition interlock license. OR |
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OPTION 2 |
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As a result of the disqualification of my commercial driving privilege, (in accordance with Section 1617 of the PA Vehicle Code) |
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OPTION 3 |
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I am applying for a non-commercial class ignition interlock license. OR |
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My ignition interlock period has been served and I am applying for the return of my previous classification. |
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NOTE: If applying for the return of your previous CDL classification, after serving your disqualifications period, you must complete form |
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DL-100CD. |
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During your ignition interlock period were you given a ticket or cited for driving without an ignition interlock system and/or tampering |
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with an ignition interlock device? |
YES |
NO |
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If yes, give date when violation occurred _____________ and check one of the following: |
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1. I was found not guilty. |
2. I paid the ticket, plead guilty or was found guilty. |
3. The case hasn't been decided yet. |
CREQUEST FOR EXEMPTION FROM PHOTO - ABSENTEE EXEMPTION
During the next 60 days I will be absent from PA for the following reason: |
Military |
School |
Work |
Travel |
Within 45 days of my return I will apply for a driver's license containing my photo.
SIGNX
HERE
APPLICANT'S SIGNATURE
DAUTHORIZATION AND CERTIFICATION (Sign and Enter Fee)
For Veterans wishing to add the Veterans Designation to their Driver's License or ID Card: I certify under penalty of law that I am a qualified applicant and hereby request it be added to my product. I understand that misrepresentation will result in the cancellation of my driver's license.
I acknowledge that receiving a Pennsylvania Permit, License or ID card will cancel or invalidate any Permit, License or ID card from another state. I certify under penalty of law that all information given on this application is true and correct. If using a Messenger Service, I hereby authorize the Department to furnish them with my driving record for the purpose of processing this form. I hereby acknowledge this day that I have received notice of the provisions of Section 3709 of the Vehicle Code. (See reverse for provisions.)
I wish to contribute $3.00 to the Organ Donation Awareness Trust Fund. (see reverse)
I wish to contribute $3.00 to the Veterans' Trust Fund. (see reverse)
SIGNX
HERE
APPLICANT'S SIGNATURE IN INK |
DATE |
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.S. Section 4904[b]).
PAID BY: |
Debit/Credit Card |
Check |
Money Order |
Payable to PennDOT (PennDOT Driver License Centers |
TOTAL $ |
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do not accept cash.) |
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MESSENGER NO. |
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DL-3731 (12-21)
The most current version of this form can be found at: www.dmv.pa.gov
SECTION A - APPLICANT INFORMATION
•Complete applicant information.
•Complete address change if needed.
•Include the Driver Number if available. This assists PennDOT in the identification process
•The Department is required to obtain the Licensee's height and eye color under the provisions of Section 1510(a) of the Pennsylvania Vehicle Code. This information will be used as identifying information in an attempt to minimize driver license fraud.
SECTION B - APPLICATION OPTIONS
•Check one block only. Indicate the type of license you are requesting.
•If you are choosing option 3, you must answer the question regarding Ignition Interlock violations. Failure to answer this question will result in the delay of processing your application.
•Return your completed and signed application with check or money order made payable to "PennDOT", to:
FOR OPTION 1 AND OPTION 2 |
FOR OPTION 3 |
Department of Transportation |
Department of Transportation |
Bureau of Driver Licensing |
Bureau of Driver Licensing |
P.O. Box 68693 |
P.O. Box 68273 |
Harrisburg, PA 17106-8693 |
Harrisburg, PA 17106-8273 |
SECTION C - REQUEST FOR EXEMPTION FROM PHOTO
• Section C must be signed.
SECTION D - AUTHORIZATION AND CERTIFICATION
•Veterans Designation: You have the opportunity to add the veterans designation to your driver's license, which clearly indicates you are a veteran of the United States Armed Forces. To qualify, you must have served in the United States Armed Forces, including a reserve component or the National Guard, and have been discharged or released from such service under conditions other than dishonorable. If you are requesting to add the veterans designation to your license, make sure you check the box at the top in Section D.
•Section D must be signed.
•Fill in the fee in the box provided. (see fees below)
FEES
Driver's License without Class M |
$31.50 |
Driver's License with Class M |
$36.50 |
or
If your license expires within 6 months, you may choose to renew at this time by attaching a DL-143 / DL-143CD
along with the renewal fees ONLY.
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ORGAN DONATION |
You have the opportunity to contribute $3.00 to the Fund. The additional $3.00 contribution must be added to your |
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payment. You must also check the block provided to ensure proper handling of your contribution. The ODTF provides |
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AWARENESS TRUST |
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for the development and implementation of donor awareness programs and funds shall be appropriated subject to the |
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FUND (ODTF) |
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approval of the Governor. |
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VETERANS’ TRUST |
You have the opportunity to make a tax deductible contribution to the VTF. Your contribution will help support programs |
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and projects for Pennsylvania veterans and their families. Since this additional $3.00 is not part of the fee, please add |
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FUND (VTF) |
the donated amount to your payment. Also, please check the proper block on the form to ensure your contribution is |
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handled properly. |
PROVISIONS OF SECTION 3709 OF THE VEHICLE CODE
Section 3709 provides for a fine of up to $300 for dropping, throwing or depositing, upon any highway, or upon any other public or private property without the consent of the owner thereof or into or on the waters of this Commonwealth, from a vehicle, any waste paper, sweepings, ashes, household waste, glass, metal, refuse or rubbish or any dangerous or detrimental substance, or permitting any of the preceding without immediately removing such items or causing their removal.
For any violation of Section 3709, I may be subject to a fine of up to $300 upon conviction, including any violation resulting from the conduct of any other persons present within any vehicle of which I am the driver.
Change your address or renew your driver's license online at www.dmv.pa.gov