Fillable Printable Restricted Driver License Application
Fillable Printable Restricted Driver License Application
Restricted Driver License Application
For validation only 106-040-254-0005
Restricted license fee
__________ Date received ___________
LSR initials __________________ Office no. _______________
RESL RESA
Restricted Driver License Application
Use this form to apply for a temporary restricted driver license if your driving
privilege in Washington is currently suspended or revoked. To apply, take this
completed application and a $100 nonrefundable fee to any driver licensing
office or mail your application and a check or money order payable to the
Department of Licensing to:
Restricted License
Department of Licensing
PO Box 3907
Seattle, WA 98124-3907
PRINT OR TYPE Name (Last, First, Middle initial) Driver license number State /Jurisdiction
Date of birth (Area code) Daytime telephone How would you like your license sent to you? (Choose one)
US mail to address on file Email Fax
Delivery information – Email or (Area code) Fax
Eligibility / Restrictions
• We will determine what type of temporary restricted license you qualify for based on our evaluation of your driving record.
• Any restricted license issued will only be valid within the state of Washington and cannot be used to operate a commercial
motor vehicle.
• We may also restrict where and when you can drive.
• Your suspension / revocation cannot be for a minor in possession, intermediate license violations, failure to pay child
support, fraud, violation of court-ordered probation, medical or vision reasons, habitual traffic offender status, failure to
enter into or comply with a required alcohol / drug treatment program, or vehicular assault or homicide (except under
certain conditions).
• You must be a Washington licensed driver or hold a valid out-of-state driver license. The restricted license is only legal
within the state of Washington.
• A second application fee is not required for a new suspension based on the same incident date.
Required documentation
• Proof of financial responsibility – the most common method is by filing a form called an SR-22. You can get one from most
automobile insurance agents.
• If you are suspended for an alcohol or drug-related offense, contact an ignition interlock company that installs Washington
certified devices. They will send us proof of installation.
If your employment requires you to drive a vehicle during working hours that is owned, leased, rented, or the temporary
responsibility of your employer, it may be exempt. You must carry a signed Employer Declaration form (DR-500-025).
This form is available at www.dol.wa.gov.
If you are indigent, you may be eligible for assistance with costs of ignition interlock device installation, removal, and leasing.
To apply, submit an Ignition Interlock Device Financial Worksheet (DR-500-024) located at www.dol.wa.gov
We must receive proof of the SR-22 insurance and any other required documentation within 30 days of receiving
this application. If not, you must submit a new application and another $100 fee.
Keeping your restricted license
Your restricted driver license will be cancelled if any of the following occurs:
• You are convicted of violating the restrictions.
• Your driving privilege is suspended or revoked while your restricted license is in effect.
• We receive evidence that your reason for driving is no longer valid.
• We receive notification that your financial responsibility (SR-22) is cancelled.
• We receive notification that your ignition interlock device is no longer functioning or has been removed.
RCW 46.20.308; 46.20.385; 46.20.391
DR-500-001 (R/8/15)WAE
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