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Dl80 Form 2016
statement on reverse side if applicable.
A YOU MUST COMPLETE ALL PARTS OF SECTION A
DRIVER’S LICENSE NUMBER
JR./ETC
LAST NAME
FIRST NAME
MIDDLE NAME
DATE OF BIRTH
MONTH
B
DAY
TELEPHONE NUMBER (8:00A.M. - 4:30P.M.)
YEAR
REPLACEMENT REQUIRED DUE TO REASON (CHECK ONE)
APPLICATION FOR REPLACEMENT (CHECK ONE)
*REGULAR CAMERA CARD
PHOTO LICENSE
*“PHOTO-EXEMPT’’ CAMERA CARD
E-MAIL ADDRESS (if applicable)
UPDATE CARD
VALID W/O PHOTO...
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