Free MV3001 - Wisconsin

Information about the Wisconsin Driver License (DL)/Identification Card (ID) Application (form MV3001) You will need to visit a DMV service center and present an MV3001 application when you are: · applying for an original or duplicate driver's license or instruction permit · renewing an existing driver's license · applying for an ID card, which can only be issued at a DMV service center (if you hold a valid Wisconsin driver's license, you are not eligible for an ID card) · applying for an occupational license An application may only be submitted through the mail if you are unable to renew or obtain a duplicate driver's license because you are a Wisconsin resident who is temporarily out-of-state. More information about renewing when out of state... Fees Applying for a license

Wisconsin Driver License (DL)/Identification Card (ID) Application Instructions
Acceptable proof of identity and residency are required. APPLICATION COMPLETION REQUIREMENTS ¨ DL customers, complete sections A, B and C. If under age 18, complete section D also. ¨ CDL customers, complete sections A, B, C and E. Your Federal Medical Certificate is required, unless you drive a school bus or drive for a political subdivision. ¨ ID card customers complete sections A and B. DONOR Responses are recorded to identify donors. You need not respond to obtain a license. Answering "yes" now authorizes an anatomical gift. To indicate your desire to make an anatomical gift check the "yes" box on this form to authorize the gift. Make sure the donor logo is either printed on your license document or that you get a sticker that you attach to it and tell your family. NOTICE to Males age 18-25 By submitting this application, you consent to be registered with the Selective Service System, if required by Federal law. You also authorize the Department of Transportation to forward any information contained in this application that is requested by the Selective Service System for the purpose of registering you as provided in s.343.14(2)(em) and s.343.234 Wis. Stats. SOCIAL SECURITY NUMBER (SSN) If you have a SSN, you must provide it. Your SSN may be used: 1) For purposes authorized by law; 2) To link your driver license and vehicle registration records. Your SSN must correspond with the number issued by the Social Security Administration, which is required by s.343.14(2)(bm) Wis. Stats. Federal regulation 49 CFR, Part 383.153 requires a SSN for commercial driver license privileges. WARNING Any person who, on applying for a driver license or ID card, presents fraudulent or altered documents or makes a false statement to the issuing officer or agency, may be subject to a fine of not more than $1,000, or imprisonment for not more than 6 months, or both, revocation of driver license privilege for one year or cancelation of the ID card. RELEASE OF INFORMATION The Department uses information provided to issue driver licenses in Wisconsin, collect fees and enforce laws. Under Wisconsin open records law and s.341.17(9) Wis. Stats., the department may make nonconfidential information available to others for business purposes. If you want your name and address withheld from vehicle record requesters, please indicate in Section A. ADA The Wisconsin Department of Transportation complies with the Americans with Disabilities Act (ADA).

OFFICE USE ONLY
Date Processor ID

Reason for Reissue Product Type

REGI
Wisconsin or Out-of-State License Number State Expiration Date

CDLI RGLR

CYCI OCCL

SPRI SPRR

JUVI JUVP AMD COA

MPDI NON

ID PROB

Legal Presence

Name/DOB Proof

Identity

Residency Proof

Application Type

ORG
Visual Acuity Without RX With RX Temporal Field of Vision In Degrees Class(es) Issued

RNW B H Expires Cash

DUP C N

REI D P

RSM M S

A
Endorsements

Right Eye

20/ 20/
Color Perception

20/ 20/
Hearing (CDL Only) Driver Education

F YES P C Check

T NO

Federal Medical Certificate Shown Left Eye Corrective Lenses

YES
Examiner ID

NO
Test Score Highway Signs

Acct.

Amount $

Knowledge

X
(Processor Signature) (Processor ID)

Clear Form
SECTION A - CUSTOMER - PLEASE PRINT
Customer Name - First, Middle Initial, Last

Check one. I am applying for:
Birth Date - Month Day Year

Driver License
Social Security Number

Identification Card

Residence Address - Street

Apt #

City

State

ZIP Code

County of Residence

Mailing Address - ONLY If Different from Residence

Apt #

City

State

ZIP Code

Sex

Race

Eyes

Hair

Weight

Height

Former Name If Changed Since Last License

Please check the box if you wish to have your name/ address withheld from lists the Department sells. Do you wish to be an organ donor? Yes No
WISCONSIN DRIVER LICENSE/IDENTIFICATION CARD APPLICATION MV3001 3/2009 Ch.343 Wis. Stats. Wisconsin Dept. of Transportation

Reason for Name Change Marriage Divorce Other

Check ONLY ONE of the following three boxes. I certify that I am a: U.S. Citizen Permanent or Conditional Permanent Resident Temporary Visitor I certify that the information on this application is true under penalty of perjury and I am a resident of Wisconsin.

X
(Customer Signature) (Date)

SECTION B - DRIVER LICENSE/IDENTIFICATION CARD CUSTOMER
YES NO 1. Has your license, ID card or operating privilege ever been revoked, suspended, cancelled, disqualified or denied? If yes, give date and place 2. Have you been convicted of operating while intoxicated OUTSIDE of Wisconsin? If yes, give date and place 3. Do you hold a valid driver's license/identification card FROM ANOTHER STATE/COUNTRY? If yes, list

SECTION C - ALL DRIVER LICENSE CUSTOMERS ONLY
YES NO 1. Do you need glasses or contact lenses for driving? 2. In the past year, have you had a loss of consciousness or muscle control, caused by any of the following conditions? If yes, check condition(s) and give date(s) Brain or Head Injury (2) Diabetes (5) Seizure Disorder (4) Stroke (2)

Heart (6) Lung (7)

Mental (3) Muscle or Nerve (2)

Years of licensed driving experience in the U.S. and Canada?

SECTION D - DRIVER LICENSE CUSTOMERS UNDER AGE 18 ONLY
Applicant Certification: I certify that in the past 6 months, I have not been ticketed for a moving violation that has or may result in a conviction. I understand that falsifying this statement will result in the cancellation of my probationary license. Applicant Signature - Required Sponsor Certification: As the adult sponsor, I accept responsibility and verify that minor is not a habitual truant and meets the educational requirements under s.343.15 Wis. Stats. and, if required for this application, has accumulated at least 30 hours of driving experience, 10 of which were at night. Minor Name - Print Sponsor Name - Print Sponsor Wisconsin DL/ID Number Sponsor Signature (Must be Notarized) Official WI DOT Test Results (line out if not used) Highway Sign Test Knowledge Test Pass Fail Pass Authorized School Official/Instructor Signature Fail Date Signed Relationship to Customer Sex Birth Date

X
School Certification: I certify under s.343.14(5) Wis. Stats., that this applicant is enrolled in approved behind-the-wheel training which begins no later than 60 days from date signed. School Name

X
State of Wisconsin County Of Subscribed and sworn to before me this date My Commission Expires

Notary Public or DOT Authorized Agent

X

X
Do NOT Use Notary Seal

SECTION E - COMMERCIAL DRIVER LICENSE CUSTOMERS ONLY
If applying for an HME, complete form MV3735. If applying for a school bus endorsement, complete form MV3740.
YES NO 1. In the past 5 years, have you had a loss of consciousness or muscle control, caused by a neurological condition, for example, seizure disorder? 2. In the past 2 years, have you taken insulin to control a diabetic condition? 3. In the past 2 years, have you taken oral medication to control a diabetic condition? 4. Is your hearing impaired? (hard of hearing) 5. Have you held a valid operator's license in the last 10 years from any jurisdiction (state) other than Wisconsin? If yes, list all states 6. In the past 5 years, have you been convicted of a felony or offense against public morals in Wisconsin or in any other state? If yes, give date and place YES NO

7. Is the vehicle you will be operating equipped with air brakes? 8. Do you meet all the driver qualifications as required by 49 CFR 391 to operate a commercial vehicle? If yes, show your valid Federal Medical Certificate to the examiner. If not, see publication BDS218. 9. Is the vehicle in which you will take the commercial driver license skill test representative of the type of vehicle you will operate or intend to operate?

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