Pennsylvania Form Dl 298 – Fill Out and Use This PDF

Are you A current PennsylvAniA resident?
o yes - continue comPleting form
o no - do not comPlete form. you Are not eligible.	PleAse tyPe or Print in blue or blAcK inK All informAtion.

AAPPlicAnt informAtion (applicant must attach a copy of their military id card, and the memorandum of authorization.)

PA License number (if applicable)

LAst nAme

jr/etc

First nAme

miDDLe nAme

DAte OF birtH

HeigHt

sOciAL security number

PA License exPires

month

day

Year

Feet

inches

month

day

Year

E-MAil AddrEss

TElEPhOnE nuMBEr (8:00 A.M. -4:30 P.M.)

eye color (Please check one):

blue

broWn

green

HAZel

PinK

blAcK

grAy

dicHromAtic

otHer ____________________

street ADDress: A Post Ofice Box number may be used in addition to the actual residence address, but cannot be used as the only address.

city

stAte

ZiP cODe

PA

bmAiling Address (complete if different than address in section A)

street ADDress: A Post Ofice Box number may be used in addition to the actual residence address, but cannot be used as the only address.

city	stAte	ZiP cODe

cdriver QuAlificAtion rePort (Authorized military Personnel must complete)

authorized military personnel must complete section c. also, a memorandum, on military letterhead, from the provost marshall, company commander, department head, or oic must be attached to certify that the examiner is authorized to administer skills testing. (attach test result)

The above applicanT, 16 yeArs of Age or older, has passed examinaTion(s) demonsTraTing qualificaTion for:

oclass c - a non-commercial license to operate a single non-commercial vehicle not over 26,000 lbs. registered gross weight (such as a passenger car, station wagon, or small truck) or any such vehicle towing a trailer not over 10,000 lbs. gross vehicle weight rating.

oclass m - a license to operate a motorcycle equipped with two wheels only.

oclass m with 8 restriction - a restricted motorcycle license, limited to operating a motor-driven cycle (not more than 5 brake horsepower).

oclass m with 9 restriction - a restricted motorcycle license, limited to only operating a 3-Wheeled motorcycle.

i the examiner, certify that the above named applicant has appeared before me and, to the best of my knowledge, has completed this application truthfully and accurately.

signAture OF tHe exAminer

titLe

DAte

exAm LOcAtiOn

SIGNX

HERE

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DL-298 (12-10)

dPHysicAl eXAminAtion certificAtion to be comPleted by medicAl officer

tHis is to certify tHe eXAminee HAs:

PHysicAl eXAminAtion of tHe APPlicAnt discloses tHe folloWing:

4 check one: yes no

please check any of the following that would prevent reasonable control of a motor vehicle:

neuropsychiatric disorders

o

neurological disorders

o

20/40 vision or less in better eye with correction. . . .

o

o

cardiac disorder

o

Report of Eye Exam Attached

o

o

circulatory disorder

o

uncontrolled epilepsy

o

Qualified

o

o

hypertension

o

cognitive impairment

o

uncontrolled diabetes

o

COMPLETE ALL ITEMS

drug abuse

Uncorrected

Corrected

o

alcohol abuse

o

20/

Right Eye

20/

o

conditions causing repeated lapses of consciousness (e.g. epilepsy, narcolepsy,

20/

Left Eye

20/

hysteria, etc.)

20/

Both Eyes

20/

specify: ________________________________________________________

R

L

Fields

R

L

if seizure disorder, date of last seizure: ________________________________

impairment or amputation of an appendage

Must wear corrective lenses

YES

NO

o

o

o

if so, list: _______________________________________________________

Other restrictions__________________________________

other:__________________________________________________________

o

signAture OF tHe exAminee (sign ONLY in presence of Physician)

NOTE: Any recommendations/additional comments must accompany this certificate on physician

X

SIGN

letterhead enclosure.

HERE

PHysiciAn inFOrmAtiOn (please print or type) check One:

o

M.d.

o

d.O.

o

C.r.P.n.

o

P.A.

o

d.C.

TElEPhOnE nuMBEr:

nAme

stAte License number

street ADDress

city

stAte

ZiP cODe

PHysiciAn’s

SIGN

PHysicAL DAte

signAture

X

HERE

econsent of PArent, guArdiAn, Person in loco PArentis or sPouse At leAst 18 yeArs of Age

complete if Applicant is less than 18 years of Age

i hereby cerTify ThaT i am a pennsylvania residenT and The: o parent o guardian o person in loco parentis or o spouse

at least 18 years of age, of the applicant named herein, that the statements made herein are true and correct to the best of my knowledge and that this application is made with my full consent.

SIGNX

HERE

(Signature of parent, guardian, person in loco parentis or spouse at least 18 years of age.)

fAutHoriZAtion And certificAtion

i certify under penalty of law that the information contained herein is true and correct. if using a messenger service, i hereby authorize the social security administration to release to the Department of Transportation information concerning my Social Security Identiication Number for the purpose of identiication. 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 page 3 for provisions.)

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]).

SIGNX

HERE

(Applicant’s signature in ink)

(Date)

greQuest for eXemPtion from PHoto

Absentee eXemPtion

during the next 60 days i will be absent from pa for the following reasons: o military o school o Work o Travel Within 45 days of my return, i will apply for a driver’s license containing my photo.

SIGNX

HERE

(Applicant’s signature in ink)

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DL-298 (12-10)

AttAcH test results

tHis form is not vAlid for commerciAl driver tests

oreQuest for originAl issuAnce of A PennsylvAniA non-commerciAl driver’s license by A PennsylvAniA resident

FEE: $29.50 (If Class M - FEE $49.50). Complete Sections A, B, C, D, E if applicable, F and G. To obtain a non-commercial driver’s license, you

F return your completed and signed application, a copy of your military Photo id card, the memorandum of authorization, and your check or money order payable to “Penndot” to:

bureau of driver licensing, P.o. box 68272, Harrisburg, PA 17106-8272.

examiner guidelines

grounds for immediate failure are:

class non-commercial A, b, or c - unable to start vehicle, striking or jumping curb or markers, unable to turnabout or park successfully

in 3 backups, serious trafic offenses (such as a passed through stop sign, passed through red light, failed to yield right of way, driving in

opposite lane continuously, improper passing, failed to obey road signs, speeding, failure to wear seat belt, or restriction violation), accident/crash, lack of cooperation, or if examinee commits any other citable trafic violation.

class m - not wearing protective headgear and protective eye device, unable to start engine, a wheelie, striking curbs or markers, serious trafic offenses (such as a passed through stop sign, passed through red light, failed to yield right of way, driving in opposite lane continuously, improper passing, failed to obey road signs, speeding, restriction violation), accident/spill, lack of cooperation, or if examinee commits any other citable trafic violation.

uIn addition to the grounds listed above, the examinee may be failed if, in the opinion of the examiner, any 2 or more of the following faults are found to be present.

All eXAminAtions

Knowledge of vehicle controls (operate headlights, turn signals, horn, etc.), improper turns, crosses center line

momentarily, following too closely, stopping in crosswalk, speed control according to conditions (too fast for conditions, slides or skids), poor judgment in trafic, failed to observe trafic (head check, failure to use mirrors, etc.), improper steering

(one hand driving, jerky motion, etc.), or improper signals or fails to signal.

class m - Foot touches ground while performing maneuvers, dificulty shifting (improper clutch/throttle control).

uIn addition to the grounds listed above, the examinee may be failed if, in the opinion of the examiner, any 4 or more of the following faults are found to be present.

All eXAminAtions

speed too slow (applicant overcautious), starting and smooth driving (does not release parking brake before attempting to move, spins wheels, stalls engine, jerky or unsmooth driving, dificulty shifting, etc.), improper braking (proper foot position on pedal, sudden or hard braking, etc.).

change your address or renew your driver’s license online at www.dmv.state.pa.us

section 3709 of tHe veHicle code

Section 3709 provides for a ine 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 ine 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.

sociAl security informAtion

The department is required to obtain the licensee’s social security number, height, and eye color under the provisions of section 1510(a) and/or 1609(a)(4) of the Pennsylvania Vehicle Code. This information will be used as identifying information in an attempt to minimize driver license fraud. Federal law permits the use of the Social Security Number by state licensing oficials for purposes of identiication.

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