Fill and Sign the Authorization to Provide Informed Consent for a Minor Kaiser

Renewing your Utah License or Identification Card on or after January 1, 2010? You will need to provide the following documentation: To ensure your process is as smooth as possible, please remember the following: Double check that you have all the correct documentation before visiting a Driver License office. Documents must be an original or a copy certified by the issuing agency. Faxed or photocopied documents will NOT be accepted. Any name or address variation from your current certificate must be accompanied by legal authorizing documentation identifying the updated information (marriage, divorce or court order). In some cases, document approval may not occur in the same day and may require an additional visit. All documents provided to the Division will be imaged and stored in a secure database and will be returned to the applicant. Documents are subject to departmental review and approval. Additional information may be required. D. Lance Davenport, Commissioner Nannette Rolfe, Director Regular Driver License, Identification Card, or CDL Present the following: 1. One legal/lawful presence document from column 1; and 2. One identity document from column 2 (may be same as legal/lawful presence document); and 3. Evidence of social security number (SSN) or proof of ineligibility to obtain a SSN from column 3; and 4. Evidence of Utah residency if the address is different from your current Utah certificate from column 4 (must provide two documents) DLD 334 12-09 Limited Term Driver License, Identification Card, or CDL Present the following: 1. One legal/lawful presence document from column 1; and 2. One identity document from column 2; and 3. Evidence of social security number (SSN) or proof of ineligibility to obtain a SSN from column 3; and 4. Evidence of Utah residency if the address is different from your current Utah certificate from column 4 (must provide two documents) Driving Privilege Card (DPC) Present the following: 1. Two identity documents from column 2 (one must be a foreign birth certificate including a certified translation if the birth certificate is not in English); and 2. Evidence of social security number (SSN) or evidence of an Individual Tax Identification Number (ITIN) from column 3; and 3. Evidence of Utah residency if the address is different from your current certificate from column 4 (must provide two documents) See reverse side for column information If you have any questions regarding appropriate documentation, please contact the Utah Driver License Division at (801) 965-4437 or toll free (888)353-4224 for assistance or visit our web site at www.driverlicense.utah.gov 1. Evidence of Legal/Lawful Presence or Status Regular Driver License, Identification Card or Commercial Driver License (May be the same as the Identity Verification document) 2. Identity Verification Regular Driver License, Identification Card or Commercial Driver License (May be the same as the Legal/Lawful Presence document) 3. Social Security Number (SSN) or Proof of Ineligibility to Obtain SSN or Individual Tax Identification Number (ITIN) - Social Security card issued by the U.S. government that has been signed and has not been laminated or, - If the Social Security card is not available, the applicant may present one of the following documents which contain the applicant's name and SSN: - Valid, unexpired U.S. passport or passport card which may provide evidence of - Valid, unexpired U.S. passport or passport card which may provide evidence of - W-2 form; both legal/lawful presence and identity; both legal/lawful presence and identity; - SSA-1099 form; - Certified copy of a birth certificate filed with the State Office of Vital Statistics or - Certified copy of a birth certificate filed with the State Office of Vital Statistics or - Non SSA-1099 form; equivalent agency in the individual's state of birth which may provide evidence of equivalent agency in the individual's state of birth which may provide evidence of - Pay stub showing the applicant's name and SSN; or both legal/lawful presence and identity; both legal/lawful presence and identity; - Other documents approved by DHS or the Division Director or - Consular Report of Birth Abroad (CRBA) issued by the U.S. Department of State, - Consular Report of Birth Abroad (CRBA) issued by the U.S. Department of State, Form FS-240, DS-1350, or FS-545 which may provide evidence of both Form FS-240, DS-1350, or FS-545 which may provide evidence of both - Letter from the Social Security Administration indicating ineligibility to receive a legal/lawful presence and identity; legal/lawful presence and identity; Social Security Number - Valid, unexpired Permanent Resident Card, Form I-551, which may provide - Valid, unexpired Permanent Resident Card, Form I-551, which may provide - CDL applicants must present a social security card evidence of both legal/lawful presence and identity; evidence of both legal/lawful presence and identity; - Certificate of Naturalization issued by DHS, Form N-550 or Form N-570, which - Certificate of Naturalization issued by DHS, Form N-550 or Form N-570, which may provide evidence of both legal/lawful presence and identity; may provide evidence of both legal/lawful presence and identity; DPC only - Certificate of Citizenship, Form N-560 or Form N-561, issued by DHS which may - Certificate of Citizenship, Form N-560 or Form N-561, issued by DHS which may Individual Tax Identification Number (ITIN) issued by the Internal Revenue Service provide evidence of both legal/lawful presence and identity; or provide evidence of both legal/lawful presence and identity; or (IRS); or - Alternate documents may be accepted if approved by DHS and/or the Division - Alternate documents may be accepted if approved by DHS and/or the Division Document or letter from the IRS verifying the ITIN Director or designee. Director or designee. Limited Term Driver License, Identification Card, or Commercial Driver License (May be the same as the Identity Verification document) Limited Term Driver License, Identification Card, or Commercial Driver License (May be the same as the Legal/Lawful Presence document) - Unexpired Employment Authorization Document (EAD) issued by DHS, Form I- 766, or Form I-688B verified by through the Systematic Alien Verification for Entitlements system (SAVE); or Entitlements system (SAVE) which may provide evidence of both legal/lawful - Unexpired foreign passport with documentary evidence of the applicant's most presence; or recent admittance into the United States verified through SAVE; - Unexpired foreign passport with documentary evidence of the applicant's most 4. Utah Residency Verification - Unexpired Employment Authorization Document (EAD) issued by DHS, Form I- 766 or Form I-688B; verified by through the Systematic Alien Verification for designee. - A document issued by the U.S. Federal Government that provides proof of one of recent admittance into the United States verified through SAVE which may provide the statuses listed below verifying lawful entrance into the United States of evidence of both legal/lawful presence. America: - Unexpired immigrant or nonimmigrant visa status for admission into the United States issued by the U.S. Federal Government; - Pending or approved application for asylum in the United States; - Admission into the United States as a refugee; - Pending or approved application for temporary protected status in the United States; - Approved deferred action status; or - Pending application for adjustment of status to legal permanent resident or conditional resident. Driving Privilege Card - Two documents which display the applicant's name and principle Utah residence address including: - Bank statement (dated within 60 days); - Court documents; - Current mortgage or rental contract; - Major credit card bill (dated within 60 days) - Property tax notice (statement or receipt dated within one year); - Foreign birth certificate including a certified translation if the birth certificate is not - School transcript (dated within 90 days) in English and one of the following: Church records, court records, driver license, employee ID, insurance ID card, Matricular Consular Card (issued in Utah), Mexican Voter Registration card, school records, Utah DPC, other evidence considered acceptable by the Division Director or designee. - Utility bill (billing date within 60 days), (cell phone bills will not be accepted); - Valid Utah vehicle registration or title; - Other documents acceptable to the Division upon review, except that only one document printed from the internet may be accepted.