(Adult - 17 Years 10 Months of Age and Older) : Dl-14A - Texas Driver License or Identification Card Application
(Adult - 17 Years 10 Months of Age and Older) : Dl-14A - Texas Driver License or Identification Card Application
(Adult - 17 Years 10 Months of Age and Older) : Dl-14A - Texas Driver License or Identification Card Application
EXAS DRIVER LICENSE OR IDENTIFICATION CARD APPLICATION FOR DEPARTMENT USE ONLY
(ADULT - 17 YEARS 10 MONTHS OF AGE AND OLDER) RESTRICTIONS/ENDORSEMENTS
NOTICE: All information on this application must be in INK. Applications held for 90 days only.
DPS CANNOT REFUND PAYMENT ONCE APPLICATION IS SUBMITTED. ASSIGNED # ������������������
Application for: _____ Driver License _____ Identification Card Class (select one): ___ A ___ B ___ C Motorcycle: ___ Y ___ N
Select one: _____ Original _____ Renewal _____ Replacement _____ Modify _____ Address or Name Change
APPLICANT INFORMATION
CONTACT INFORMATION
Residence Address:�����������������������������������������������������������������������������������������������������������������������
City:_______________________________________________________ State: _______ Zip Code:____________ County:���������������������������������������
Mailing Address:��������������������������������������������������������������������������������������������������������������������������
City:_______________________________________________________ State: _______ Zip Code:____________ County:���������������������������������������
Primary Phone:________________________ Cellular Phone*:________________________ Email:��������������������������������������������������������
*Standard data and messaging rates may apply
In the event of injury or death would you like to provide up to two (2) emergency contacts? If yes, please list:
a) Name ____________________________________ Phone Number __________________ Address��������������������������������������������������������
b) Name ____________________________________ Phone Number __________________ Address��������������������������������������������������������
Alternate Address: (Authorized Personnel Only)�������������������������������������������������������������������������������������������������
City:_______________________________________________________ State: _______ Zip Code:____________ County:���������������������������������������
7. Have you EVER been referred to the Texas Medical Advisory Board for Driver Licensing?
NOTICE: The information on this application is required by the Texas Driver License Act, Texas Transportation Code Chapter 521. Failure to
provide the information is cause for refusal to issue a driver license or identification card, and in some cases, cancellation or withdrawal of
driving privileges. False information could also lead to criminal charges with penalties of a fine up to $4,000.00 and/or jail.
DO NOT SIGN BELOW UNTIL INSTRUCTED TO DO SO BY NOTARY PUBLIC OR DRIVER LICENSE EMPLOYEE.
CERTIFICATION
I do solemnly swear, affirm, or certify that I am the person named herein and that the statements on this application are true and correct.
I further certify my residence address is a (select one): ___ single family dwelling, ___ apartment, ___ motel, ___ temporary shelter. I agree to
immediately report to the Texas Department of Public Safety any changes in my medical condition which may affect my ability to safely operate
a motor vehicle. I further understand that I am required by law to report any change of name or address to the Department of Public Safety
within thirty days.