alaska driver license application pdf (D1 Form)

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Form D1 (Rev: 0 9/01 /2022) STATE OF ALASKA DIVISION OF MOTOR VEHICLES DRIVER LICENSE, PERMIT OR IDENTIFICATION CARD TRANSACTION APPLICATION FIRST NAME MIDDLE NAME LAST NAME SUFFIX ALASKA LICENSE/ID #  N ew DATE OF BIRTH SOCIAL SECURITY NUMBER  N one SEX HEIGHT (Feet/Inches ) WEIGHT (LBS) HAIR COLOR EYE COLOR BIRTH CITY BIRTH STATE (if USA) BIRTH COUNTRY CONTACT INFORMATION (Residence Address must be printed on REAL IDs ) CITY STATE ZIP MAILING ADDRESS : RESIDENCE ADDRESS :  Same as Mailing Address EMAIL ADDRESS PHONE NUMBER IDENTIFICATION CARD:  Standard  REAL ID COMMERCIAL PERMITS & LICENSES COMMERCIAL ENDORSEMENTS OPTIONAL DESIGNATORS DRIVING CREDENTIAL:  Standard  REAL ID Class A:  CDL  Permit Class B:  CDL  Permit Class C:  CDL  Permit  Passenger  School Bus  Doubles/Triples  Tank  Hazardous Mat erials  Veteran  Hidden Disability  Class - D Instruction Permit  Class - D Driver License  Motorcycle Permit  Motorcycle License Remember: a form of REAL ID wi ll be required for commercial air travel beginning May 07 , 202 5 1. What is your Lawful Status?  U.S. Citizen  U.S. National  Non- U.S. Citizen 2. Ha ve you ever been known by a different legal name?  Yes  No Name(s):_______________________________________________ 3. Wo uld you like to be an organ donor? (Selecting No will cancel your current organ donor status, if applicable)  Yes  No 4. Wo uld you like to register to vote or make changes to your voter registration?  Yes  No 5. If you marked “Yes” to the previous question, do you meet the eligibility requirements described below to vote?  Yes  No Only answer the following questions if you are applying for a permit or license 6. Within the last 10 years, have you held an instruction permit or driver license in another state?  Yes  No Date(s) and State(s):____________________________________________ 7. Ha ve your driving privileges ever been suspended or revoked, and/or have you had a driving application denied?  Yes  No Date and Reason:_________________________ ______________________ 8. Wi thin the past 5 years, have you had a medical condition or impairment, mental or physical disorder, seizure, or any other serious health problem that may affect your ability to safely operate a motor vehicl e?  Yes  No Explanation:____________________________________________________ VOTER ELIGIBILITY INFORMATION: To register to vote, you must be a US Citizen, an Alaska resident, and 18 years of age or older, or within 90 days of turning 18. If you decline to register to vote, the fact that you have declined to register will remain confidential and will be used only for voter registration purposes. If you register to vote, the office at which you submit this voter registration application will remain confidential and will be used only for voter registration purposes. To vote, you cannot be under 18, registered in another jurisdiction, judicially determined to be of unsound mind, or convicted of a felony involving moral turpitude, unless, having been so convicted, you have been unconditionally discharged from incarceration, probation, and/or parole. I. I certify under penalty of perjury all information provided on this form is true. False statements are punishable under AS11.56.210 & AS 15.56.050. II. I acknowledge that by receiving an Alaskan credential, any other credential from another state may be cancelled or invalidated. III. I understand the type of license(s) that are available to me , and I have chosen the license that I would like. IV. If I made an anatomical gift, I understand the information on my license will be transmitted to a donor registry created under AS 13.50.110. V. I understand it is my responsibility to notify DMV if my license is destroyed or mutilated or if my anatomical gift is revoked under AS 13.52.183. VI. If I registered to vote using this form, I meet the requirements to register to vote, I will meet the requirements to vote, and I am not regi stered to vote in another jurisdiction or I agree to cancel that registration. ________________________________________________________________________________________________ _____________________ Applicant Signature ( must sign in front of DMV rep ) Date DMV REP LDAP/Office # D1 Form D1 (Rev: 0 9/01 /2022) PARENT/LEGAL GUARDIAN CONSENT FOR DRIVING CREDENTIAL If you are a minor applying for a driving credential th is section must be completed. A legal document proving relationship is required for initial consent of minors . NAME of PARENT or LEGAL GUARDIAN : _____________________________________________________________________________________ RELA TIONSHIP to APPLICANT: _______________________________________ LICENSE/ID NUMBER: _________________________________ (or a lternate ID information ) By signing below, I certify : I. I am eligible to authorize this minor for the applicable credential, as pursuant to AS 28.15 .071. II. If this minor is applying for a provisional license, they have had at least 40 hours of driving experience, including at least 10 hours in progressively challenging circumstances. III. I understand I am liable for damages caused by the minor when driving a motor vehicle and I may file a written request with DMV to cancel the license or permit. _______________________________________________________________________ ________________ Adult Sign ature ( must sign in front of DMV rep or notary ) D ate DMV REP LDAP / Office # THE SECTION BELOW SHOULD ONLY BE USED IF YOU ARE UNABLE TO SIGN IN FRONT OF A DMV REPRESENTATIVE Subscribed before me this ________ day ________ of, 20___ Notary Signature :____________________________________________________ Commission Expiration Date: _ __ __ ______ DMV USE ONLY BELOW REQUIRED VISION TEST RESULTS : Corrective Lenses:  Yes  No Left: 20/ ____ Both: 20/ ____ Right: 20/ _____ CDL C OLOR BLIND TEST RESULTS:  Pass  Fail MED CARD PROVIDED:  Yes  No PHYSICIAN NOTE PROVIDED :  Yes  No DOCUMENTS ACCEPTED:____________________________________________________________________________________________ KNOW LEDGE TESTS:  General  Motorcycle  Alcohol & Drug Awareness CDL KN OWLEDGE TESTS:  CD L General  Combination  Air Brake  Double/Triple  Passenger  School Bus  HazMat  Tank ROAD TESTS PASSED:  Non -Commercial  Motorcycle  Commercial DATE :____________ BATCH #:_________________ LDAP:_____________ OFFICE #:__________ PAYMENT TYPE:________________ ADDIT IONAL INFORMATION/NOTES: (SEAL)