Obtaining a driver's license or an Ohio ID card requires proof of residency, a need that can present challenges for individuals unable to provide conventional documents to verify their Ohio street address. Recognizing this, the Ohio Department of Public Safety Bureau of Motor Vehicles offers a solution through the Proof of Ohio Residency-Certified Statement form. This critically important form ensures that residents without standard proof can still verify their address through alternative means. It serves various groups, including dependent children whose parents or guardians can certify their address, married individuals whose spouses can provide verification, and people whose circumstances necessitate confirmation by an agency, such as those living in a homeless shelter, nursing home, halfway house, or those being aided by faith-based or other legitimate social services agencies. The completion requirements are clear: all information must be legibly printed, with all fields filled except those marked as optional. This process includes a signature portion for the applicant and, if applicable, for the parent, guardian, spouse, or authorized agency agent verifying the applicant's residency. The form not only facilitates access to essential identification documents but also underscores the state's commitment to accommodating its residents' diverse needs. With an emphasis on accuracy and legality, the form contains a stern warning about the penalties for falsification, reinforcing the seriousness of the information provided.
| Question | Answer |
|---|---|
| Form Name | Proof Of Residency Letter Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | proof of residency letter pdf, proof of residency letter doc, voter, proof of residency letter template pdf |
OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
PROOF OF OHIO
This form must be completed when the Applicant for an Ohio driver’s license (DL) or Ohio ID card cannot provide proof of an Ohio street address through documents listed on the Ohio BMV Acceptable Documents List.
A dependent child may have an address confirmed by a parent or guardian who has proof for the same address. A married person may have an address confirmed by a spouse who has proof for the same address.
An Applicant may have the address confirmed by an appropriate Agency (homeless shelter, nursing home,
PLEASE TYPE OR PRINT ALL INFORMATION LEGIBLY. ALL FIELDS ARE REQUIRED, EXCEPT WHERE NOTED. (*)
APPLICANT’S FIRST NAME
MIDDLE NAME OR INITIAL
LAST NAME
DATE OF BIRTH
OHIO STREET ADDRESS
CITY
STATE
OHIO
ZIP CODE
I certify that I am the person described above, that I am a permanent resident of the state of Ohio, that I do not have documentary proof for the above street address, that I am authorized to use the above address to receive mail and legal notices, and that I request that the address be entered as my address on any Ohio driver license or Ohio ID issued to me.
APPLICANT’S SIGNATURE: X |
DATE: |
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CERTIFICATION BY PARENT OR GUARDIAN OF DEPENDENT CHILD OR SPOUSE OF MARRIED APPLICANT
PARENT OR |
GUARDIAN |
SPOUSE |
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FIRST NAME |
MIDDLE NAME OR INITIAL |
LAST NAME |
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I certify that I am the parent, stepparent, guardian, or spouse of the applicant as indicated above, that the applicant is a permanent resident of the state of Ohio, that my address and the applicant’s address are the same, and that I have presented documentary proof
of my Ohio resident street address.
PARENT/GUARDIAN/SPOUSE SIGNATURE: X |
DATE: |
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OR CERTIFICATION BY SOCIAL SERVICES AGENCY (IF NO PARENT, GUARDIAN, OR SPOUSE CERTIFICATION)
NAME OF AGENCY
DESCRIBE NATURE OF AGENCY (HOMELESS SHELTER, NURSING HOME,
ADDRESS OF AGENCY |
CITY |
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STATE |
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ZIP CODE |
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NAME OF AUTHORIZED AGENT |
TELEPHONE NUMBER |
*FAX NUMBER OR EMAIL ADDRESS (Optional) |
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I certify that I am an authorized agent of the above Agency, that the Applicant described above is a client of or is known to the Agency, that to the best of my knowledge and belief the applicant is a permanent resident of the state of Ohio, that the applicant does not currently have documentary evidence of a permanent street address, but that the applicant can receive mail and legal notice at the address listed above.
AUTHORIZED AGENT’S SIGNATURE: X |
DATE: |
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WARNING: This document is part of an application for a state license or ID. Making a false statement on this document may constitute the crime of falsification, a misdemeanor of the first degree, RC 2921.13.
BMV USE ONLY (VERIFICATION) |
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AGENCY CONFIRMATION |
DATE |
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PROOF PRESENTED BY PARENT/GUARDIAN/SPOUSE |
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D/R EMPLOYEE |
MANAGER OR DEPUTY REGISTRAR |
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BMV 2336 4/10