Application for Driver License - New Hampshire - Edit, Fill, Sign Online

FIRST NAME (REQUIRED) MIDDLE (REQUIRED) LAST NAME (REQUIRED) SUFFIX (Sr, Jr, etc.)

ADDRESS WHERE YOU GET YOUR MAIL (REQUIRED)

ADDRESS WHERE YOU LIVE (REQUIRED)

(ALL ARE REQUIRED)

DATE OF BIRTH SEX HEIGHT WEIGHT EYE COLOR HAIR COLOR

(REQUIRED IF FIRST OR ORIGINAL N.H. DRIVER’S LICENSE)

SOCIAL SECURITY INFORMATION TELEPHONE NUMBER (OPTIONAL) E-MAIL ADDRESS (OPTIONAL)

( ) -

State of New Hampshire Department of Safety

Division of Motor Vehicles

APPLICATION FOR DRIVER LICENSE OR NON-DRIVER ID CARD

PLEASE PRINT CLEARLY IN BLUE OR BLACK INK

Original License/NH license Renewal Duplicate Non-Driver ID Card Replacement Reason:

in exchange for a license from _______________________

another US State, the District of _______________________

Columbia or Canadian Province Motorcycle Endorsement (includes 3 Wheel

or a US Territory and motor driven cycle)

I AM APPLYING FOR (CHECK ANY THAT APPLY):

STREET APT. # CITY OR TOWN STATE ZIP CODE

OPTIONAL (CHECK ANY THAT APPLY)

I have paid all resident taxes or Interest and Dividends Tax (RSA 77) for which I am liable, and, if required, insurance

certificates are on file with the Director of Motor Vehicles. My driving privileges are not subject to or under disqualifi-

cation, suspension or revocation by any jurisdiction (does not apply to non-driver ID).This application is signed under

penalty of unsworn falsification pursuant to RSA 641:3.

SIGN HERE DATE

Make checks payable to: State of NH - DMV

MONTH DAY YEAR MALE FEMALE FEET INCHES POUNDS

IDENTIFICATION INFORMATION

Are you a United States Citizen? YES NO

Are you a New Hampshire Resident? YES NO

Do you have, or did you ever have a New Hampshire driver license or non-driver ID card? YES NO

Do you have or did you ever have a driver license that is valid or that expired within the past twelve months issued by another

US State, the District of Columbia or a Canadian Province? YES NO

If “YES”, where was it issued? ___________________________ Date of Expiration: _____________________________________

Type of License:_______________________________________ License ID No.: ________________________________________

FEE SCHEDULE

LICENSE TYPE ORIGINAL RENEWAL LICENSE TYPE ORIGINAL RENEWAL

Operator $50.00 $50.00 Motorcycle Only $55.00 $55.00

Duplicate $10.00 $10.00 Motorcycle Endorsement $30.00 $ 5.00

Non-Driver Identification $10.00 $10.00 Motor Driven Cycle $55.00 $55.00

Operator/Motorcycle $55.00 Moped $ 8.00 $ 8.00

DSMV450 (Revised 04/12)

Payment Method: CASH CHECK CREDIT CARD MONEY ORDER

FOR QUESTIONS REGARDING DMV LOCATIONS AND HOURS OF OPERATION

PLEASE GO TO

WWW.NH.GOV/DMV OR CALL 603-227-4000.

DMV USE ONLY

I wish to have my social security number removed from DMV Records, pursuant to RSA 263:40-a.

Check Here to Consent to Organ & Tissue Donation pursuant to RSA 263:41

Donation information will be provided to federally-designated organizations so that your decision to donate may be honored.

I do not wish to have my photograph retained in the records of the Department of Safety. (RSA 260:14).

I wish to have my legal address appear on the back of my driver license or I.D. card.

I am 18 years old and consent to registration with the Selective Service System as required by Federal Law.

(RSA263:5-c).

I wish to add the Veteran Indicator

I wish to have my social security

number removed from DMV

Records, pursuant to RSA 263:40-a

I do not wish to have my photo-

graph retained in the records

of the Department of Safety

(RSA 260:14)

I wish to have my legal address appear on the back of my

driver license or I.D. card

I am 18 years old and consent to registration with the Selective

Service System as required by Federal Law (RSA 263:5-c)

DSMV450 (Revised 10/14)

PLEASE CHECK BOX IF MAILING AND LEGAL ADDRESS ARE THE SAME

Fillable Printable Application for Driver License - New Hampshire

Fillable Printable Application for Driver License - New Hampshire

Application for Driver License - New Hampshire