Pa Dl 3731 Form – Fill Out and Use

DL-3731 (4-16)

APPLICATION FOR IGNITION INTERLOCK

LICENSE/RETURN OF REGULAR DRIVER LICENSE

PLEASE READ IMPORTANT INFORMATION ON THE REVERSE SIDE.

AAPPLICANT INFORMATION

DRIVER'S LICENSE NUMBER

LAST NAME

JR/ETC

FIRST NAME

MIDDLE NAME

DATE OF BIRTH

TELEPHONE NUMBER (8:00 A.M.-4:30 P.M.)

E-MAIL ADDRESS (if applicable)

Month

Day

Year

EYE COLOR (Please check one):

BLUE

BROWN

GREEN

HAZEL

PINK

BLACK

GRAY

DICHROMATIC

OTHER_____________________

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:

		US Armed Forces		Federal Government				Pennsylvania State Government
Relationship to person meeting exemption (check one):							Spouse			Dependent Child

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

NEW

STREET

ADDRESS

CITY	STATE	ZIP CODE

If you are a registered voter in PA, would you like us to notify your county voter registration ofice of this change?			YES			NO
If you are not a registered voter, you may contact your county voter registration ofice.
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			I am applying for an ignition interlock license. OR
OPTION 2			As a result of the disqualiication of my commercial driving privilege, (in accordance with Section 1617 of the PA Vehicle Code)
			I am applying for a non-commercial class ignition interlock license. OR
OPTION 3			My ignition interlock period has been served and I am applying for the return of my previous classiication.
			NOTE: If applying for the return of your previous CDL classiication, after serving your disqualiications period, you must complete
			form DL-100CD.
			During your ignition interlock period were you given a ticket or cited for driving without an ignition interlock system and/or tampering
			with an ignition interlock device? YES		NO
			If yes, give date when violation occurred _____________ and check one of the following:
			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)

Veterans Designation: I certify under penalty of law that I am a qualiied 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 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 $1.00 to the Organ Donation Awareness Trust Fund. (see reverse)

I wish to contribute $3.00 to the Veterans' Trust Fund. (see reverse)			FEE PAID
X			SEND CHECK
SIGN			IN THIS
HERE
			AMOUNT
APPLICANT'S SIGNATURE IN INK	DATE

WARNING: Misstatement of Fact is a misdemeanor of the third degree punishable by a ine of up to $2,500 and/or imprisonment up to 1 year (18 Pa. C.S. Section 4904[b]).

MESSENGER NO.

DL-3731 (4-16)

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 identiication 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 68272
Harrisburg, PA 17106-8693	Harrisburg, PA 17106-8272

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	$28.50	Driver's License with Class M	$33.50
		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.

	ORGAN DONATION	You have the opportunity to contribute $1.00 to the Fund. The additional $1.00 contribution must be added to your
		payment. You must also check the block provided to ensure proper handling of your contribution. The ODTF provides
	AWARENESS TRUST
		for the development and implementation of donor awareness programs and funds shall be appropriated subject to the
	FUND (ODTF)
		approval of the Governor.
		You have the opportunity to make a tax deductible contribution to the VTF. Your contribution will help support programs
	VETERANS’ TRUST	and projects for Pennsylvania veterans and their families. Since this additional $3.00 is not part of the fee, please add
	FUND (VTF)	the donated amount to your payment. Also, please check the proper block on the form to ensure your contribution is
		handled properly.

Change your address or renew your driver's license online at www.dmv.pa.gov