CA DMV DL 44 Form - Fill, Edit Online, Download & Print - No Signup
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____________________
_______________________________________________________________________________________________
44
Signature
X
Date
4
LICENSING NEEDS:
3
the appropriate box(es). Refer to the
California Driver Handbook for additional information.
B
ASIC LICENSE
Basic Class C
Motorcycle
If basic license only, go to Part 5.
NON-COMMERCIAL LICENSE
Class A
Class B
AMBULANCE CERTIFICATE
5
THE FOLLOWING QUESTIONS MUST BE ANSWERED:
6
DO YOU WISH TO REGISTER TO VOTE OR CHANGE POLITICAL AFFILIATION OR VOTER ADDRESS?
DO YOU WISH
TO REGISTER TO
VOTE OR CHANGE
Y
YES—Complete the
attached voter form.
N
NO—Do not complete
attached voter form.
VOTER
CHANGE
OF
ADDRESS
I am a registered voter; I moved and wish to update my voter record.
C
to a new county—Complete the attached voter form.
S
within the same county—Do not complete the attached
form. Your voter record will be automatically updated.
7
to the Donate Life California organ and tissue donor
a pink donor dot will be printed on the front of your driver license or identifcation
you are currently registered, you must check “YES!” to have the pink donor dot
your license or identifcation card. If you wish to remove your name from the
must contact Donate Life California (see back). The Department of Motor
can only remove the pink donor dot from your license or identifcation card.
8
FOR DRIVER UNDER 18, PARENT/GUARDIAN SIGNATURES REQUIRED:
If both parents/guardians have joint custody,
BOTH MUSTSIGN
. I/We accept civil liability for this minor.
Mother’s/Guardian’s Signature
X
Date
Daytime Phone Number
(
)
CONFIDENTIAL
POLITICAL AFFILIATION?
DO YOU WISH TO
REGISTER TO BE AN
ORGAN AND TISSUE
DONOR?
If you mark “YES!” you will be added
registry and
card. If
printed on
donor registry, you
Vehicles
YES! I want to be an organ and
tissue donor.
$2 voluntary contribution to
support and promote organ and
tissue donation.
DO YOU WISH TO REGISTER TO BE AN ORGAN AND TISSUE DONOR?
Sex
M
F
Hair Color
Eye Color
Height
Weight
3
COMPLETE THIS SECTION ONLY IF YOU
ARE NOT
ELIGIBLE FOR A SOCIAL SECURITY NUMBER:
HQ
MICROGRAPHICS
USE ONLY
A Public Service Agency
DRIVER LICENSE OR IDENTIFICATION CARD APPLICATION
DO NOT DUPLICATE
Driver License
OR
ID Card Number
State
OR
Country
Expires
Birth Date
Social Security Number
First Name
Middle Name
Last Name
Suffx
(Jr., Sr., III)
DRIVER LICENSE (DL)
IDENTIFICATION CARD (ID)
NAME CHANGE/
Original DL/Permit
Remove Restriction
Original ID Card/Renewal
CORRECTION
Renewal
Change/Add Class
Senior ID Card/Renewal (Age 62+)
DL
Duplicate
Replacement
ID CARD
____ Lost ____ Stolen
____ Lost ____ Stolen
Complete Parts 2,
Complete Parts 2 through 8.
Complete Parts 2, 3, 5A, 6 & 7 only.
3, 5, 6 & 7 only.
PLEASE PROVIDE THE FOLLOWING:
NOTE:
You must use your true full name. Original documentation may be required. Refer to the
California Driver Handbook.
FOR DMV USE ONLY
BD/LP Code ___________________
State/Country __________________
DOCUMENT#
_____________________________
Review: Primary _______________
Secondary Tech ID/Date
_____________________________
PURPOSE FOR YOUR VISIT:
the appropriate box(es).
PRINT USING BLACK OR BLUE INK ONLY.
READ ALL INFORMATION PROVIDED ON THE FRONT AND BACK OF THIS FORM.
/
/
–
–
1
/
/
MO
DAY
YR
MO
DAY
YR
3
2
Mailing Address, P.O. Box, or Private Mail Box
(
Include Box Number, St., Ave., Rd., Blvd., etc.
)
,
Number, Street, Apt/Space No., City, State, Zip Code
Address Where You Live
(
If different from mailing address
)
, Number, Street, Apt/Space No., City, State, Zip Code
I certify under penalty of perjury under the laws of the State of California that no Social Security Number has ever been issued to me and I am not presently eligible
for a Social Security Number. I understand that pursuant to Vehicle Code Section 12801 I must provide my Social Security Number to the Department of Motor
Vehicles when one is assigned to me.
A.
Have you applied for a Driver License or Identifcation Card in California or another state/country using a different name
or number within the past ten (10) years? ............................................................................................................................................................
Yes
No
If yes, print name, DL/ID number, and state or country _______________________________________________________________________________
B.
Have you had your driving privilege or a driver license cancelled, refused, delayed, suspended, or revoked?......................................................
Yes
No
If yes, indicate date and reason below.
DATE
REASON
C.
Within the last fve years, have you had or experienced any of the medical conditions specifed on the back of this form
that affects your ability to operate a motor vehicle safely?
Please read the “Medical Information” on the back of this
form before answering.
................................................................................................................................................................................
Yes
No
If yes, briefy explain: _________________________________________________________________________________________________________
Address
Street
Apt No.
City
State
Zip
Father’s/Guardian’s Signature
Date
Daytime Phone Number
Address
Street
Apt. No.
City
State
Zip
X
(
)
9
CERTIFICATION:
I have read, understand and agree with the contents of this form, including the certifications on the
BACK
of this form.
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
STOP
Do not sign until instructed to do so by a DMV employee.
Applicant’s Signature
X
FOR DMV FIELD OFFICE USE ONLY
Date
Daytime Phone Number
(
)
DL 44 (REV. 10/2008)
IT IS IMPORTANT THAT YOU READ AND UNDERSTAND
THE FOLLOWING INFORMATION AND CERTIFICATIONS
MEDICALINFORMATION
The following conditions that may affect your ability to operate a motor vehicle safely include, but are not limited to:
• loss of consciousness; or
• episode of marked confusion caused by any condition which may bring about recurring lapses; or
• disease, disorder, or disability (examples of these are epilepsy, diabetes, stroke, cataracts, Parkinson’s disease); or
• decrease or change in your vision due to cataracts, macular degeneration, diabetic retinopathy, glaucoma, retinitis
pigmentosa, or other progressive condition; or
• health problems because of alcohol or drug abuse.
VOTER REGISTRATION
If the voter has not received voter registration information within 30 days of requesting it, they should contact the Local Elections Office of the
Office of the Secretary of State.
ORGAN DONOR STATEMENT
If you marked on the front of the application that you want to be an organ and tissue donor upon death, your consent shall
serve as a legally binding document as outlined under the California Uniform Anatomical Gift Act. Except in the case where
the donor is under the age of 18, the donation does not require the consent of any other person. For donors under the age of
18, the legal guardian of the donor shall make the final decision regarding the donation. If you want to change your decision to
consent in the future, or if you want to limit the donation to specific organs, tissues or research, you must contact Donate Life
California by mail at 1760 Creekside Oaks Drive, # 220, Sacramento, CA 95833 or online at
www.donateLIFEcalifornia.org
,
or
www.doneVIDAcalifornia.org
.
DISCLOSURE STATEMENTS
•
SOCIAL SECURITY NUMBER COLLECTION DISCLOSURE — You are required by law to provide your Social Se-
curity Number, if you are eligible for one, or your application will be denied. An applicant who is legally present
in the United States, but not authorized to work and therefore ineligible for a Social Security Number may still
be eligible for a California Driver License/Identification Card.
Authority to collect the social security number is United States Code, Title 42, Chapter 7, Subchapter II, Section 405 and California Vehicle
Code §1653.5, §12800, and §12801. It will be used in the administration of driver license laws and motor vehicle registration laws and
to respond to requests for information from the:
• Franchise Tax Board for tax administration
• Any agency operating pursuant to 42 U.S.C. 601 et seq.
It will be used to aid in the collection of monies owed in connection with:
3
failure to pay fines or failure to appear in court by an applicant
3
Aid to Families with Dependent Children
3
Child Support
3
Establishment of Paternity
• DMV verifies your social security number, name and birth date on our records with the Social Security Administration. You will not be
issued or be able to renew your driver license or identification card until the Social Security Administration verifies the information you have
provided is correct. By applying for a driver license or identification card, you authorize and consent to a search of any and all databases
at the Social Security Administration by the California Department of Motor Vehicles, to verify the information you have provided.
• DMV checks for driving record status in other jurisdictions through the National Driver Registry prior to issuance of a California driver
license. You will not be issued a California driver license if another jurisdiction has withdrawn your driving privilege.
• The mailing address listed on the front of this application will be the address shown on your driver license or identification card.
ADVISORY STATEMENT
The information required on this form pertains to eligibility for and issuance of a driver license. It is required under the authority of Division 6
of the California Vehicle Code. Failure to provide the information is cause for refusal to issue a driver license, or, in some cases, cancellation
or withdrawal of the driving privilege.
• Exceptasmade confidential(medicalinformationis confidential underauthorityofCaliforniaVehicleCode§1808.5)orexemptedunderthe
Public Records Act, this information is a public record and is regularly used by law enforcement agencies and insurance companies.
• Access to address information is now restricted, and will be available to various authorized requesters for limited use. Individuals can
obtain copies of their own information during regular office hours.
CRIMINAL PROSECUTION
• If you submit fraudulent information, the DMV may pursue criminal prosecution.
• Any person who uses false documents to conceal his or her true citizenship or resident alien status is guilty of a felony pursuant to
California Penal Code §114.
REFUNDS
• Once this application form and fee have been submitted, no refunds will be made.
CERTIFICATIONS
• I agree to submit to a chemical test of my blood, breath, or urine for the purpose of determining the alcohol or drug content of my blood
when testing is requested by a peace officer acting in accordance with California Vehicle Code §23612.
• I am hereby advised that being under the influence of alcohol or drugs, or both, impairs the ability to safely operate a motor vehicle.
Therefore, it is extremely dangerous to human life to drive while under the influence of alcohol or drugs, or both. If I drive while under
the influence of alcohol or drugs, or both, and as a result, a person is killed, I can be charged with murder.
• By signing this application, I certify that I was notified that if I am under 21 years of age, I cannot legally drive with a blood alcohol
concentration (BAC) of 0.01% or more. Driving with a BAC of 0.01% or more, or refusing to take, or failing to complete an alcohol
screening or drug test, results in a one-year suspension of my driving privilege.
• By signing this application, I certify that I was notified that if I am currently on court probation for a driving under the influence offense, I
cannot legally drive with a blood alcohol concentration (BAC) of .01% or more. Driving with a BAC of .01% or more results in a one-year
suspension of my driving privilege. Refusing to take, or failing to complete an alcohol screening or chemical test will result in a two to
three year suspension/revocation of my driving privilege.
• I am the person whose name appears on the front of this form. The mailing address shown is valid, existing, and
accurate. I agree to accept service of process at this mailing address according to §§415.20(b), 415.30(a), and §416.90 of the California
Civil Procedure Code.
• I understand DMV may add traffic convictions reported by other states or jurisdictions to my driving record that may result in sanctions
against my California driving privilege.
• By signing this form, I am acknowledging my presence in the United States is authorized under federal law.
• I understand I may have no more than one driver license in my possession or under my control in accordance with
California Vehicle Code §12511.
DL 44 (REV. 10/2008)
