Fillable Printable DMV Record Change Request Form - New Hampshire

DMV Record Change Request Form - New Hampshire

STATE OF NEW HAMPSHIRE

DEPARTMENT OF SAFETY

DIVISION OF MOTOR VEHICLES

23 HAZEN DRIVE, CONCORD, NH 03305-0001

(603) 227-4000

www.nh.gov/dmv

John J. Barthelmes

Commissioner of Safety

Richard C. Bailey Jr.

Director of Motor Vehicles

RECORD CHANGE REQUEST

Note: This request will change data on all DMV records (Registration, Driver License, Title, etc.)

Please complete form accordingly for permanent changes only.

1. Person’s Information: (Please Print)

NAME:

FIRST MIDDLE LAST DATE OF BIRTH

DRIVER LICENSE NUMBER / NON

DRIVER IDENTIFICATION NUMBER

BEST CONTACT PHONE

NUMBER (RECOMMENDED)

EMAIL ADDRESS

2. Address Change: If you would like a replacement license/ID with the updated information go to any

DMV Office and you may purchase a replacement at a cost of $3.00.

MAILING ADDRESS:

STREET CITY/TOWN STATE ZIP CODE

Check this box if the legal address is the same as the mailing, if different please complete legal address below.

LEGAL ADDRESS:

STREET

CITY/TOWN STATE ZIP CODE

Check this box if you wish to have your legal address appear on the back of your driver license or ID.

NOTE: If an updated license is requested, applicant must appear in person and present current license to any DMV office, at a cost of $3.00.

Please check if you wish to add the Veteran Indicator.

Office Use only: Cash □ Check □ Credit □

3. Name Change: Must appear in person at any DMV Office with supporting documentation.

Marriage Certificate, Divorce decree, Adoption decree, Court decree, Name Change Petition from Probate Court, Passport.

NEW NAME:

FIRST MIDDLE LAST SUFFIX (Jr. Sr. I, II, etc)

4. Other Personal Identification Information: To change Date of Birth you must appear in person

at any DMV Office with supporting documentation. Original or certified copy of Birth Certificate, valid

Passport or valid Military ID.

Height Weight Eye Color Hair Color Gender Date of Birth (mm/dd/year)

Donor Information:

Check Here To Consent to Organ Donation pursuant to RSA 263:41.

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

honored.

Check here to remove your consent to Organ and Tissue donation.

I, the undersigned applicant, certify under penalty of unsworn falsification pursuant to RSA 641:3, all

information provided is correct and true.

Signature:_________________________________________ Date:_______________________________

DSMV 30 (Rev 10/14)