Fillable Printable Id Card Application Form - Wisconsin
Fillable Printable Id Card Application Form - Wisconsin
Id Card Application Form - Wisconsin
WISCONSIN IDENTIFICATION CARD (ID) APPLICATION
Wisconsin Department of Transportation (WisDOT)
MV3004 7/2015Ch. 343 Wis. Stats.
Wisconsin ID cards used for voting are FREE. Check the box
ID for FREE on the back.
An unexpired Wisconsin driver license is acceptable photo ID for voting. (s. 5.02(6m) Wis. Stats.)
You cannot hold both a driver license and Wisconsin ID card at the same time. (s. 343.50(1)(b) Wis. Stats.)
To get started:
Complete this application form MV3004.
If you have a Social Security number, you must provide it. (s. 343.14(2)(bm Wis. Stats.)
If you are NOT a U.S. citizen, present proof of legal presence every time you apply.
To get your rst (original) Wisconsin ID card:
SURRENDERORPRESENT ACCEPTABLE PROOF* OF
Your current unexpired Wisconsin
driver license
Name and date of birth
Legal presence
Identity
Wisconsin residency
Name change (if applicable)
NOTE: If your documents proving U.S. citizenship, name and date of birth, or legal name change
are unavailable, and you are applying for an ID card for the first time and it is for voting purposes,
you may use the document verification petition process by completing both this application
form MV3004 and form MV3012 DMV Administrator Petition – Unavailable Documentation.
To get a REAL ID-compliant ID card:
SURRENDERORPRESENT
Your REAL ID-compliant Wisconsin
driver license
All of the documents above
Acceptable proof* of Social Security number
To renew your ID card or get a replacement (duplicate):
Present acceptable proof* of identity (a previously issued Wisconsin ID or driver license is sufcient).
SOCIAL SECURITY NUMBER (SSN) If you have an SSN, you must provide it. (s. 343.14(2)(bm) Wis. Stats.) Your SSN may be
used for purposes authorized by law and to link your driver and vehicle registration records. Your SSN must correspond with the
number issued by the Social Security Administration.
NOTICE TO MALES AGE 18–25 By submitting this application, you consent to be registered with the Selective Service System, if
required by Federal law. You also authorize WisDOT to forward any information contained in this application that is requested by the
Selective Service System for the purpose of registering you as provided in s. 343.14(2)(em) and s. 343.234 Wis. Stats.
ADAWisDOT complies with the Americans with Disabilities Act (ADA)
WARNING Any applicant for a Wisconsin Identication Card who presents fraudulent or altered documents or makes a false statement
to the issuing ofcer or agency, may be subject to a ne of not more than $1,000, imprisonment for not more than 6 months or both and
cancellation of fraudulently obtained Wisconsin Identication Card. (s. 343.14(5) Wis. Stats.)
RELEASE OF INFORMATION Wisconsin Identication Card information may only be shared with courts, district attorneys, county
corporation counsel, city, village or town attorney, law enforcement, the applicant or the applicant’s parent or legal guardian if the
person is under age 18.
* ACCEPTABLE PROOF DMV publishes a list of acceptable documents. Ask for Acceptable Documents for a Wisconsin
Driver License or ID Card application (publication BDS316) at your local DMV service center or look for it online at:
www.wisconsindmv.gov/dl-docs.
OFFICE USE ONLY
REAL ID
Application Type
ORG RNW DUP REI RSM
DateProcessor IDPayment Amount
Check Cash CC Acct.$
Wisconsin or Out-of-State License Number State Expiration Date
Legal PresenceName/DOB ProofIdentity/SS ProofResidency Proof
X
(Processor Signature) (Date)
APPLICANT – PLEASE PRINT
Applicant Name – First, Middle, Last
Birth Date
M M D D Y Y Y Y
Social Security Number
1 2 3 4 5 6 7 8 9
Residence Address – Street Apt # City State ZIP Code County of Residence
Mailing Address – ONLY IF DIFFERENT from Residence Apt # City State ZIP Code County of Residence
SexRaceEyesHairWeightHeightFormer Name (if changed since last license or ID card)
1. Do you wish to register to be an organ, tissue and eye donor?
Will you donate $2 to organ, tissue and eye donation efforts?
YES
YES
Reason for Name Change
Marriage Divorce Other List:
2. OPT OUT – Do you wish to have your name and
address withheld from lists WisDOT sells?
YES
5. Check ONLY ONE of the following three boxes.
I certify that I am a:
U.S. Citizen
Permanent or Conditional Permanent Resident
Temporary Visitor
3. Do you hold a valid driver license/identication card
FROM ANOTHER STATE/COUNTRY?
If yes, list:
YES
NO
4. ID for FREE – I certify that I am a U.S. citizen,
will be at least 18 years of age by the next election
and require a Wisconsin ID for free to vote.
YES
6. I am a veteran registered with WDVA and wish to
have my veteran status indicated on my ID Card.
(DMV is required to verify your status with WDVA.)
YES
I certify that the information on this application is true under penalty of perjury and I am a resident of Wisconsin. (s. 343.14(5) Wis. Stats.)
X
(Applicant Signature) (Date – mm/dd/yyyy)
All ID cards used for voting are FREE
Check the box
ID for FREE
DONOR Check the box if you wish to help others by donating your organs, tissue and eyes upon your death. Your gift will be used
to save and improve lives through transplantation, research or education. If you are at least 18, checking the box indicates your legal
consent for donation. You do not have to answer this question to obtain an ID card.
OPT OUT Under Wisconsin open records laws, WisDOT must provide information from its records to requesters. If you do not want
your name and address included in requests we receive for ten or more records, you may ask WisDOT to withhold your name and
address from those lists by checking the box on the application.
FOR MORE INFORMATION VISIT www.wisconsindmv.gov
WISCONSIN IDENTIFICATION CARD (ID) APPLICATION (continued)
Wisconsin Department of Transportation MV3004
