Fillable Printable Application for Driver License or ID Card - Florida

Application for Driver License or ID Card - Florida

COMPLETE THIS PAGE AND CONTINUE TO NEXT PAGE Page 1

Manatee County Tax Collector

APPLICATION FOR DRIVER LICENSE OR ID CARD

_VISIT TAXCOLLECTOR.COM TO SCHEDULE AN APPOINTMENT_

This form is also available at taxcollector.com

Are you at the right office?

Specialized transactions must be completed at our Specialized Driver License Department, 819 301 Blvd W,

Bradenton; and many services that we offer require an appointment. Examples of specialized transactions would be learner licenses,

road/written tests, non-US citizens, reinstatements due to suspension, vision testing issues/retakes and commercial licenses (CDL). Refer to

Section 3 below for additional examples. Note: Appointments scheduled for the wrong location or service will not be honored.

1 - WHY ARE YOU HERE?



Driver License



ID Card (

If requesting an ID card, your driver license will be cancelled.) 

Learner License -

APPOINTMENT REQUIRED

2 - MARK YOUR CITIZENSHIP/LEGAL PRESENCE STATUS

Mark One Status:  US Citizen  Naturalized US Citizen or US Citizen Born Abroad -

APPOINTMENT REQUIRED

 Not a US Citizen (Immigrant, Permanent Resident/Green Card, Non-Immigrant or Temporary Resident) -

APPOINTMENT REQUIRED

3 - MARK THE SERVICE(S) YOU NEED

Fees are approximate and a $15 late fee or $7 endorsement fee may apply.

Available At

Any Office

Appointments

are strongly

encouraged.

Limited Services for US CITIZENS (See Specialized Services for Naturalized Citizens, Citizens Born Abroad & Non-US Citizens.)

 Renew Florida Driver License or ID Card - $31.25 to $54.25

 Replacement Driver License or ID Card - $31.25 (or $6.25 with police report that specifically states “stolen”)

 Address Change or Name Change with Proof of the Change - $31.25

 Transfer Out-of-State Driver License or ID Card (license/ID must be available) - $31.25 to $54.25

 Add Motorcycle Endorsement (Motorcycle Rider Course must already be complete) - $38.25

 Learner Upgrade to Class E (you passed Driver’s Ed or passed the Driving Skills Road Test with a 3

party) - $6.25 to $54.25

 Convert a Driver License to ID Card - $31.25

 Add Veteran “V” Designation on Driver License or ID Card - $6.25 & up

Available at

Specialized

Driver License

Department

Only

819 301 Blvd W

Bradenton, FL

34205

Appointments

are required for

most

transactions.

Specialized Services for NON-US CITIZENS, US CITIZENS, & NATURALIZED CITIZENS

APPOINTMENT REQUIRED FOR THE FOLLOWING SPECIALIZED SERVICES (visit taxcollector.com):

 Non-US Citizen (Renewal, Replacement, Address Change, Transfer Out-of-State) - $31.25 & up

 Naturalized Citizen & Citizen Born Abroad (Renewal, Replacement, Address Change, Transfer Out-of-State) - $31.25 & up

 Transfer Out-of-State Driver License or ID Card to Florida when License/ID is Lost or Stolen - $31.25 & up

 First-Time (in Lifetime) ID Card Issuance (never had a government-issued ID in any US state) - $31.25 & up

 Sexual Predator/Offender & Career Offender (any transaction; appointment required beginning 10/1/15) - $6.25 & up

APPOINTMENT REQUIRED FOR THE FOLLOWING TESTING SERVICES (visit taxcollector.com):

Must be a Manatee County resident with proof of residency. A retest fee ($10 & up) may apply.

 Driving Skills Road Testing (for Class E) - $6.25 & up

 Written Testing (Learner License, First-Time Class E, Commercial/CDL) - $6.25 & up

 Learner License (Written Testing needed in person or already passed online) - $6.25 & up

 Medical Testing, Re-Exams & Issues/Questions - $6.25 & up

 Hazmat/CDL Driving Skills Road Testing (not offered; see receptionist)

APPOINTMENT REQUIRED (beginning 8/1/15) FOR THE FOLLOWING COMMERCIAL/CDL SERVICES (visit taxcollector.com):

 Renew Florida CDL, Replacement, Transfer from Out-of-State, Address Change, Name Change, etc. - $31.25 & up

 Downgrade CDL to Class E Driver License (standard operator license) or Upgrade Class E to CDL (testing complete) - $6.25 to $81.25

 CDL Medical Card/Certificate Update (update online for free at flhsmv.gov; some restrictions may apply) - $6.25

OTHER SERVICES AVAILABLE:

 Notice of Pending Suspension, Insurance Update and Research - $6.25

 Reinstatement of Driving Privilege Due to Suspension, Revocation, etc. - $21.25 & up

 DUI or Ignition Interlock Restriction- $281.25 & up

 Hardship License Issuance (must have Bureau of Administrative Review/BAR Approval) - $31.25 & up

 Traffic School Issue/Reinstatement - $6.25

 License Status Check - $6.25 & up

 Other (Explain): _______________________________________________________________________________ - $6.25 & up

COMPLETE SECTION 4 & SIGN SECTION 11 ONLY FOR THE FOLLOWING SERVICES:

If you need any other services not listed below, complete entire application.

 Traffic Ticket Clearance and Reinstatement of Driving Privilege (D6 suspension) - $66.25

 Driving Transcript; 3-Year, 7-Year or Complete Record (not certified) - $14.25 & up

 Eye/Vision Exam or Vision Report Update - $6.25 & up

This form must be completed and turned

in to a receptionist by 4:30 PM to

complete your transaction.

COMPLETE THIS PAGE AND CONTINUE TO NEXT PAGE Page 2

4 - PRINT YOUR PERSONAL INFORMATION

This information will be used to create your Florida Driver License or ID Card.

FULL FIRST NAME ADDRESS WHERE YOU RECEIVE MAIL

Street Address or PO Box

FULL MIDDLE NAME

City

State

Zip

FULL LAST NAME ADDRESS WHERE YOU LIVE

(If different than above)

Street Address (No PO Box)

SUFFIX DATE OF BIRTH SEX HEIGHT

Jr, Sr, III, etc

Month Day Year

Male



Female



Feet Inches

City

State

Zip

ETHNICITY (Required as part of the applicant’s description per s. 322.08, F.S.) STATE OF BIRTH COUNTRY OF BIRTH



Asian



Black



Hispanic



Native American



White



Other

5 - ALL APPLICANTS MUST ANSWER THE FOLLOWING

 Yes  No Other than the driver license or ID card that you may be presenting today, do you have any other US state-issued

driver licenses or ID cards in your possession? Does not include employee, school or military ID cards, or concealed

weapons permits, etc. NOTE: All US driver licenses and ID cards must be surrendered to our office.



Yes



No Have you ever been licensed in any US state(s) other than your current driver license in your lifetime?

 Yes  No Do you want to save a life by becoming/remaining an organ donor?



Yes



No Are you a Florida resident?

 Yes  No Help us help you! If you are unable to complete your transaction today, you are responsible for retaining this

application and other necessary documents. You will be required to present this application and other necessary

documents upon your return visit.



Yes



No I understand that customers with an appointment will be served before walk-in customers. Visit taxcollector.com to

schedule an appointment for your return visit.



Yes



No I understand that I can receive sample ballots and other voting information from the Supervisor of Elections by calling

941.741.3823, emailing info@votemanatee.com or visiting votemanatee.com.

 Yes  No I understand that a person who knowingly makes a false statement in writing with the intent to mislead a public

servant in the performance of his official duty shall be guilty of a misdemeanor of the second degree, punishable as

provided in s. 775.085, s. 775.083 or s. 775.084, Florida Statutes.



Yes



No I understand that I have the option of donating additional funds to one of the 15+ non-profit organizations listed in

s. 322.08, Florida Statutes. A computer can be used in each of our lobbies to access a complete list of organizations.

10.

Are you an insulin dependent diabetic? Be prepared to provide your answer verbally.

6 - DRIVER LICENSE APPLICANTS MUST ANSWER THE FOLLOWING



Identification Card applicants, skip to Section 7.

11.  Yes  No Have your driving privileges ever been suspended, revoked or denied in any state(s) in your lifetime?

If yes, list the most recent state:

12.  Yes  No Have you ever been convicted of an alcohol or drug-related driving offense in your lifetime?

If yes, check one:  3 times within the last 10 years  2 times within the last 5 years  Neither

13.  Yes  No Do you need a commercial driver license (CDL)? If yes, you must let the receptionist know you need to complete the

Commercial Driver License Application (separate form).

The following questions must be answered verbally during your transaction. Do not write your responses below.

14. Have you ever been adjudged by a court of law to be mentally incapacitated, suffering from any mental disorder or disease?

15. Have you suffered from epilepsy, fainting or dizzy spells within the last 2 years?

16. Are you addicted to drugs or intoxicants?

17. Do you have any physical or mental disabilities that could affect your driving?

COMPLETE THIS PAGE AND CONTINUE TO NEXT PAGE Page 3

7 - FEDERAL REAL ID REQUIREMENTS FOR IDENTITY VERIFICATION

A STAR on your Florida driver license or Florida ID card means you are already Real ID compliant. There are

a couple of different designs in circulation. An example is shown on the right.

If any of the following situations apply to your transaction, see the Additional Identification Requirements

section on the top of Page 4 for documentation required to process your transaction. Otherwise, skip to

Section 8 below.



TRANSFERS FROM OUT-OF-STATE/OUT-OF-COUNTRY



CURRENT FLORIDA LICENSES OR ID CARDS WITHOUT A STAR

 CHANGES TO PERSONAL INFORMATION (NAME OR ADDRESS) ON FLORIDA LICENSES OR ID CARDS WITH A STAR

NOTE: Non-US citizens are required to show INS (USCIS) documentation at every visit.

8 - EMERGENCY CONTACT INFORMATION (s. 119.0712, F.S.)

Providing this information is completely voluntary. If you don’t want to provide this information, skip to Section 9.

Provide all information below. You can add a secondary contact and make other changes anytime online by visiting services.flhsmv.gov/eci.

Primary Contact Full Name: Phone #: ( )  Home  Work  Cell

Relationship to Applicant:  Spouse  Parent  Sibling  Child  Grandparent  Extended Family  Friend  Other

Primary Contact Address: City State Zip

9 - VETERAN INFORMATION (s. 322.14, F.S.)

Providing this information is completely voluntary. If you don’t want to provide this information, skip to Section 10.

 Yes  No Are you an honorably discharged military veteran? If yes, answer the following questions. If no, skip to Section 10.

 Yes  No Are you a 100% disabled veteran with documentation from the Veteran’s Administration to prove it?



Yes



No Would you like to be contacted about federal/state benefits you may be entitled to as a result of military service? If

yes, provide your email address:

 Yes  No Would you like a “V” designation (for Veteran) printed on the front of your driver license or ID card? (Add $1-$2.) You

must be able to provide proof of honorable discharge, such as a DD-214 or Military Retired ID Card, to qualify.

10 - VOTER’S REGISTRATION APPLICATION (s. 97.057, F.S.)

Providing this information is completely voluntary. If you don’t want to provide this information, skip to Section 11.

Select ONE of the following options:

 Option 1: I am currently registered to vote in Florida and I don’t need to make any changes (skip to Section 11).

 Option 2: I need to change the following info on my Florida voter’s registration card:  Address  Party  Name

 Option 3: I would like to apply for a first-time Florida voter’s registration card. If registered in another state, provide your out-

of-state address: City: State: Zip:

 Yes  No Are you a convicted felon? Required per s. 97.041, F.S. If yes, have your voting rights been restored?  Yes  No

NOTE: Your voting rights must have been restored in order to be eligible to apply for a Florida voter’s registration.



Yes



No Do you require voting assistance?

 Yes  No Are you interested in being a poll worker? A poll worker prepares the precinct by setting up voting equipment and

providing voters with appropriate ballots. Refer to votemanatee.com for details.

 Yes  No Are you Active Duty Military or Merchant Marine?

 Yes  No Are you the dependent of Active Duty Military or Merchant Marine?



Yes



No Are you a US Citizen currently residing outside of the US?

I do solemnly swear (or affirm) that I will protect and defend the Constitution of the United States and the Constitution

of the State of Florida, that I am qualified to register as an elector under the Constitution and laws of the State of

Florida, and that all information provided in this application is true.

11 - OATH AND ACKNOWLEDGMENT (Required per s. 322.08, F.S.)

Under penalty of perjury I (the applicant) swear or affirm that the information given by me in this application is true and correct.

Signature of Applicant: Date:

INITIAL HERE

-- THE END --

Please turn this form in to the Receptionist

COMPLETE THIS PAGE AND CONTINUE TO NEXT PAGE Page 4

Concerns & Complaints about Real ID

Contact your US Senate or House of Representatives member(s):

US Senate



Marco Rubio: 202.224.3041or http://rubio.senate.gov



Bill Nelson: 202.224.5274 or http://billnelson.senate.gov

House of Representatives



Vern Buchanan: 202.225.5015 or http://buchanan.house.gov



Thomas Rooney: 202.225.5792 or http://rooney.house.gov

Florida Division of Motorist Services



gathergoget.com

850.617.3995 (7 AM - 5:45 PM, Monday - Friday)

ADDITIONAL IDENTIFICATION REQUIREMENTS

The Federal Real ID Act requires documentation that establishes your identity when applying for a Florida driver license or ID card. Refer to

the top of Page 3 to see if this applies to you. Below is a snapshot of the most common identity documents provided. For a complete list of

acceptable identity documents and to create a personalized checklist just for you, visit gathergoget.com.

DON’T HAVE THE DOCUMENTS THAT ARE REQUIRED IN PERSON?

Many transactions may be processed online at taxcollector.com!



Conduct business anytime: 24 hours a day, 7 days a week



Simply key in some personal info to access your record



Pay by credit or

debit card



You don’t have to supply identity documents (as you do in person), which gives you more time to gather them for a future visit.

NEED HELP REPLACING YOUR DOCUMENTS?

The easiest and fastest way to determine what documents you need and where to get them is by visiting gathergoget.com.

State & Government Agency Documents

US Birth Certificates



Florida: Manatee County Health Department at 941.748.0747



All States: vitalchek.com or cdc.gov/nchs/w2w.htm



Hospital birth certificates are not acceptable

US Passports & Passport Cards



Manatee County Court House at 941.741.4020



http://travel.state.gov/content/travel/english.html

Marriage Certificates & Divorce Decrees



Manatee County: Court House at 941.749.1800



All States: vitalchek.com or cdc.gov/nchs/w2w.htm



Church marriage certificates are not acceptable

Social Security Cards



Local Social Security Administration Office at 800.772.1213



socialsecurity.gov

Veterans & Military Service Records - Replacement DD-214



http://www.archives.gov/veterans/military-service-records/

Office Use Only (Including SDL) SDL Office Use Only

Form Reviewed/Processed by: Customer Assistance Provided by:

Associate # & Initials: Associate # & Initials:

Date: Date:

Transaction Processed:



Driver License



ID Card



Temporary

TLSAE #: Date: Est. Fee:

Vision: P / F Date: Associate # & Initials:

Restriction(s): Learner:



Yes



Rev. 7/2015

BRING ONE:



Unexpired US Passport



Original US Birth Certificate





Certified US Birth Certificate





Naturalization Certificate



INS (USCIS) Documentation



Cannot be issued by a hospital

Does the name match your

license or ID card? If not, don’t

forget your name change

documents; see box #4 on right.

BRING ONE:



Social Security Card or Stub



W-2/1099 Form (pre-printed)



Pay Stub



L-676 Form (# never issued)

Proof must list full name and full

Social Security #.

Name changes must be reported

to Social Security at least 24

hours prior to visiting our office.

BRING TWO:



Car or Boat Registration



Utility Bill or Credit Card Bill



Bank Statement



Voter Registration Card



Lease Agreement



Insurance Policy/Card



Other Verifiable Mail

Must show name and address.

BRING ALL THAT APPLY:



Original Marriage Certificate



 Certified Marriage Certificate





Divorce Decree



Court Order



Cannot be from a church

This is only required when a prior

name (or maiden name) is shown

on the identification document

provided; see box #1 on left.



 



Commercial Driver License Application

Must be accompanied by the Application for a Driver License or ID Card form

SECTION

1 - MARK THE TYPE OF TRANSACTION YOU ARE HERE TO COMPLETE

 I need to renew, replace or be issued a CDL license. Proceed to Section 2.

 I am here for written CDL testing and/or a temporary CDL permit. Skip to Section 3.



I am here to update my CDL medical certification on file. Proceed to Section 2. (The CDL applicant must be present or have

signed this form to update medical certification information in the office). NOTE: Updates can be done online, eliminating a

visit to the Manatee County Tax Collector’s Office and payment of the service fee. Visit https://services.flhsmv.gov/CDLMedCert/.

 I want to downgrade from a CDL license to a regular operator’s license (Class E). NOTE: When downgrading, all CDL testing

information will remain on file as long as a valid Florida license is maintained. Skip to Section 4.

 I am here to clear a CDL disqualification. Proceed to Section 2.

SECTION

2 - MEDICAL CERTIFICATION: DECLARE YOUR CATEGORY

ALL CDL applicants are required to self-certify into one of the categories below per § 383.71 Federal Motor Carrier Safety

Regulations. For complete category details, visit fmcsa.dot.gov/faq.

MARK ONE OF THE FOLLOWING CATEGORIES:

 CATEGORY A: NON-EXCEPTED INTERSTATE (MOST COMMON) **MEDICAL CARD REQUIRED** - I operate or expect to

operate in interstate commerce and am required to maintain federal medical certification. If you operate in both interstate

AND intrastate, you must select this category. Interstate is defined as: commerce between 2 states or a foreign country;

between two places within a state but crosses into another state or foreign country; between two places within a state, but

cargo/passengers are part of a trip that began or will end in another state or foreign country.

 CATEGORY B: EXCEPTED INTERSTATE - I operate or expect to operate in interstate commerce, but engage exclusively in

operations that qualify me for an exception from the requirement to maintain federal medical certification. Common

interstate exceptions: school bus operations; transportation by a federal, state or local government; occasional transport of

personal property (personal use/without compensation); emergency operations.

 CATEGORY C: NON-EXCEPTED INTRASTATE **MEDICAL CARD REQUIRED** - I operate or expect to operate only in

intrastate commerce and am required to maintain State of Florida medical certification. Intrastate is defined as: transporting

goods or passengers without crossing a state border and not for any portion of a direct shipment into or out of the state.

 CATEGORY D: EXCEPTED INTRASTATE - I operate or expect to operate only in intrastate commerce, but engage exclusively

in operations that qualify me for exception from State of Florida medical certification. Common Intrastate exceptions:

transport of agriculture/forestry products between the farm/place of harvest and a market or first place of storage; driving

commercially for an electric/phone company within 200 miles of where vehicle is based; operation of a private school bus seating

less than 24 passengers; operation as a driver/salesman within 100 miles of the workplace, conviction free.

UNEMPLOYED - CDL holders can no longer claim exemption from medical certification because they are not employed or

currently operating in non-excepted interstate or intrastate commerce. One of the categories above must be selected.

IMPORTANT: If you self-certify in CATEGORY A or C above, you are required to show a medical card. It must be completed in

full by a qualified physician and must include the national registry ID #. It must be legible and cannot contain any alterations,

cross-outs, white-out or any other corrections. See fmcsa.dot.gov for details about medical card requirements. If you are unable

to provide an acceptable medical card, you will be subject to our $6.25 service fee and you will be required to obtain a new card.

By entering the expiration date from the medical card and initialing below, I hereby acknowledge that my medical card meets the

federal and/or State of Florida requirements.

Medical Card Expiration Date: _______________________ Applicant’s Initials: __________

Proceed to Section 3

SECTION

3 - REQUIRED APPLICATION QUESTIONS

This section must be completed if you are RENEWING, REPLACING OR BEING ISSUED A CDL LICENSE.

 Yes  No Are you physically qualified to operate a commercial motor vehicle per §391.41 of the Federal Motor Carrier

Safety Regulations? “Physically qualified” includes but is not limited to having both feet, legs, hands and

arms, as well as having no established clinical diagnosis or medical history of a condition or disease, or other

impairment that would interfere with your ability to safely operate a commercial motor vehicle. For a

complete list of physical qualifications, visit fmcsa.dot.gov/.

 Yes  No Are you applying for employment or are you currently employed with a public or private school system that

requires you to hold a CDL license?

If YES, do you have your public/private school employment ID card or letter from your employer? This is

required in order to qualify for a reduced fee for an original issuance or a renewal.



Yes



Yes



I certify that the motor vehicle that I used to take the CDL Driving Skills Road Test represents the type of

motor vehicle I operate or expect to operate. If NO, you may be subject to additional testing.



Yes



Have you been licensed in any state other than Florida in the last 10 years?

If yes, what state(s)? Include license #’s (if known):

Proceed to Section 4

SECTION

4 - WARNINGS AND OATH

(MUST BE COMPLETED BY ALL APPLICANTS)

ALL APPLICANTS must complete this section.

You hereby acknowledge the following:



It is your responsibility to determine the appropriate selection and whether an exception applies to you. Severe fines,

penalties and incarceration are possible for violators who operate under an incorrect selection, do not maintain certification

or provide any false/incorrect information to obtain a CDL license. We strongly suggest that you seek legal advice, the advice

of your employer or consult the appropriate state and federal regulations. Drivers are urged to visit flhsmv.gov and

FMCSA.gov for information and regulations. Computers are available in our office lobby.



If I verbally declared that I am an insulin dependent diabetic, I acknowledge that an intrastate restriction (2) will be added to

my CDL license. This statement does not apply if you did not verbally declare that you are an insulin dependent diabetic.

 You must review your driver license before you leave the office and inform staff of any error (endorsements, restrictions,

spelling/address corrections, license types, etc.) so that they can be corrected. Once you leave the office, the transaction

cannot be voided or cancelled and corrections/changes will be subject to standard reissue fees.

Under penalty of perjury I (the applicant) swear or affirm that the information given by me in this application is true and correct.

Printed Name of Applicant:

Signature of Applicant: Date:

STAY CONNECTED TO THE TAX COLLECTOR’S OFFICE!

Important updates, newscasts, lobby wait times, office locations and other information is just a click or

text away! Visit our website taxcollector.com, or:



Follow ManateeTax on Facebook, Twitter & YouTube.



Search Manatee Tax in Google Play & Apple Store to download our free app, which allows you to pay

online, get lobby wait times, news & more.



Check our lobby wait times! Text the word WAIT to 41411 or scan the QR code on the right with your

smartphone to see the number of customers waiting in our lobbies and the estimated wait time.

(Standard text messaging rates may apply.)



Get driver handbooks at floridadmvbooklet.com. Driver handbooks are available in English and

Spanish.

WAIT TIMES

Rev. 02/2015