The DL-80 Pennsylvania form is an application used for requesting changes, corrections, or replacements of a non-commercial driver’s license. This form allows individuals to update personal information, replace lost or stolen licenses, and make necessary corrections without the need for a fee in certain circumstances. Proper completion of the form ensures that all requests are processed efficiently by the Bureau of Driver Licensing.
The DL-80 form is an essential document for Pennsylvania residents looking to make changes to their non-commercial driver’s license. Whether you need a replacement due to loss or damage, or you wish to update personal information such as your address or name, this form is your go-to resource. It’s crucial to fill out the application accurately and completely, as incomplete submissions can lead to delays. The form includes sections that require notarization for certain requests, ensuring that your application is processed efficiently. Additionally, if you are under 18, parental consent is necessary for specific changes, particularly regarding organ donor designations. The DL-80 also addresses various scenarios, such as changes in eye color or height, and it provides options for voters to update their registration information. Understanding the nuances of this form can save you time and hassle, so it’s imperative to follow the instructions closely. As you prepare to submit your application, remember that fees may apply depending on the type of request you are making, and be sure to include all necessary documentation to support your application. This form is not just a piece of paper; it represents your driving privileges and personal identity in Pennsylvania, so handle it with care.
DL-80 (3-11)
NON-COMMERCIAL DRIVER’S LICENSE
APPLICATION FOR CHANGE / CORRECTION / REPLACEMENT PLEASE TYPE OR PRINT IN BLUE OR BLACK INK ALL INFORMATION
Bureau of Driver Licensing • P.O.Box 68272 • Harrisburg, PA 17106-8272
CHECK APPLICABLE BLOCK:
PLEASE READ IMPORTANT INFORMATION ON THE REVERSE SIDE.
REPLACEMENT (DUPLICATE) – Complete Sections A, B, (C & D if applicable),
CHANGE OR CORRECTION of Non-Commercial License.
E and F. All requests marked with an asterisk (*) MUST be notarized.
Complete Section A, C and F. Notarization is not required.
Complete absence statement on reverse side if applicable.
An update card will be issued.
A YOU MUST COMPLETE ALL PARTS OF SECTION A
DRIVER’S LICENSE NUMBER
LAST NAME
JR./ETC
FIRST NAME
MIDDLE NAME
DATE OF BIRTH
TELEPHONE NUMBER (8:00A.M. - 4:30P.M.)
E-MAIL ADDRESS (if applicable)
MONTH
DAY
YEAR
B
APPLICATION FOR REPLACEMENT (CHECK ONE)
REPLACEMENT REQUIRED DUE TO REASON (CHECK ONE)
ORGAN DONOR
*REGULAR CAMERA CARD
PHOTO LICENSE
UPDATE CARD
LOST
MUTILATED
DESIGNATION
STOLEN
CORRECTION
ADD (parental consent in
*“PHOTO-EXEMPT’’ CAMERA CARD
VALID W/O PHOTO LICENSE
*NEVER RECEIVED
OTHER ______________________
Section D required
if under 18)
(STATEMENT ON REVERSE MUST BE COMPLETED AND SIGNED)
(No Fee Required)
_____________________________
REMOVE
CCHANGE OR CORRECTION ONLY (Important information on reverse side)
ADDRESS CHANGE -A Post Ofice Box number may be used in addition to the actual residence address, but cannot be used as the only address. See reverse if using an out-of-state address.
NEW
STREET
ADDRESS
CITY
STATE
PA
ZIP CODE
If you are a registered voter in PA, would you like us to notify your county voter registration office of this change?
YES
NO
If you are not a registered voter, you may contact your county voter registration office.
NAME CHANGE
OTHER (see reverse side)
REASON:
MARRIAGE
DIVORCE
LAST
JR., ETC.
OTHER CHANGES
EYE COLOR (Please check one):
BLUE
BROWN
GREEN
HAZEL
PINK
BLACK
GRAY
DICHROMATIC
OTHER ________________
CORRECTION OF DATE OF BIRTH
HEIGHT
SOCIAL SECURITY NUMBER
DROP PRIVILEGE
FEET
INCHES
DROP CLASS M
CONSENT OF PARENT, GUARDIAN, PERSON IN LOCO PARENTIS OR SPOUSE AT LEAST 18 YEARS OF AGE. Complete if
D Applicant is less than 18 years of age to give consent for Applicant’s request for Organ Donor Designation.
I hereby certify that I am a
SIGN
Parent,
Guardian,
Person in Loco Parentis
Spouse at least 18 years of age and I:
HERE
Do give consent
Do not give consent for applicant’s request for Organ Donor Designation.
X
(SIGNATURE OF PARENT, ETC.)
E
ALL MUST BE
No person may hold more than one valid license at any time. If you have a license from another state, do not use this form. YOU MUST go
to a Driver License Examination Center to surrender your out-of-state license and make application for a replacement PA license.
ANSWERED IF
1.
NO - Is your driver’s license or driving privilege suspended or revoked in this state or any other state?
REPLACEMENT
2.
NO - Have you been arrested or cited in this state or any other state for any violation which carries a possible penalty of suspension or
IS REQUESTED
revocation of your driver’s license or driving privilege?
If yes, give state_________ Date ______________ and Reason ___________________________________________________________
FAUTHORIZATION AND CERTIFICATION
I certify under penalty of law that all information given on this application is true and correct. I hereby
AFFIDAVIT: This section must be notarized when applying for replacement of a
authorize the Social Security Administration to release to the Department of Transportation information
Camera Card. You are entitled to a free replacement ONLY if this application is
concerning my Social Security Identication Number for the purpose of identication. If using a Messenger
completed within 90 days of the original date of issuance and the original was
Service, I hereby authorize the Department to furnish them with my driving record for the purpose of
never received due to loss in the mail.
processing this form. I hereby acknowledge this day that I have received notice of the provisions of Section
SUBSCRIBED AND SWORN
3709 of the Vehicle Code. (See reverse for provisions.)
FEE PAID
TO BEFORE ME:
MO.
I wish to contribute $1.00 to the Organ Donation
SEND CHECK
IN THIS
Signature of Person Administering Oath
Awareness Trust Fund (see reverse).
AMOUNT
SEE REVERSE FOR FEES
S
WARNING: Misstatement of fact is
SIGN IN PRESENCE OF NOTARY
a misdemeanor of the third degree
punishable by a ine of up to $2,500
A
and/or imprisonment up to 1 year
L
(18 PA C.S. Section 4904(b)).
(APPLICANT’S SIGNATURE IN INK)
For More Drivers License Information - http://pa-license.com
APPLICANT INFORMATION
•Photo Exemption: Complete form as indicated. Sign both Section ‘’F’’ and the statement below. PennDOT will send you a camera card and further instructions.
During the next 60 days I will be absent from PA for the following reason:
Military
School
Work
Travel
Within 45 days of my return I will apply for a driver’s license containing my photo.
XSIGN
SIGNATURE HERE
•OUT-OF-STATE ADDRESS CHANGE. We may not issue driver license products to an out-of-state address, except in the case of an employee of the federal or state government, armed forces personnel, and immediate members of their families, whose workplace is located outside of Pennsylvania. If this exception applies to you, please check the appropriate box and include documentation of your status with this application. Attach a letter from your employer on their letterhead to document your status, or attach a copy of your current Photo ID issued by your employer. If you are the immediate family of a person meeting one of the allowable exceptions, attach the documentation of the person employed. Additionally, you must indicate your relationship to that person.
I certify that my workplace is located out of state and I am employed by, or am the immediate family of a person employed by:
US Armed Forces
Federal Government
Pennsylvania State Government
Relationship to person meeting exemption (check one):
Spouse
Dependent Child
•Return your completed and signed application with check or money order made payable to "PennDOT", to: Bureau of Driver Licensing, P.O. Box
68272, Harrisburg, PA 17106-8272.
•If your license is due to expire within six (6) months, DO NOT use this form. Complete form DL-143 (Renewal of a Non-Commercial Driver’s License).
•If you ind or recover your original license after you have submitted this application for a duplicate, return the original license with a letter of explanation to: Bureau of Driver Licensing, P.O. Box 68615, Harrisburg, PA 17106-8615. After duplicate is issued, the original license is no longer valid.
REPLACEMENT OF
APPLICATION FOR REPLACEMENT OF A CAMERA CARD OR A PRODUCT NEVER RECEIVED MUST
NON-COMMERCIAL:
BE NOTARIZED IN SECTION F.
PHOTO OR VALID W/O
FEE: $13.50 - The Bureau will issue a camera card, which is a temporary Non-Commercial Driver’s License
valid for 60 days. During those 60 days, the driver must appear at a photo driver license center for the
PHOTO NON-COMMERCIAL
purpose of having a photo taken. If photo image is on ile, the Bureau will issue a Photo Driver’s License.
DRIVER’S LICENSE
If license is endorsed with Class M, fee is $18.50.
*REGULAR OR “PHOTO
FEE: $5.00 if photo was not taken with the original camera card.
EXEMPT” CAMERA CARD
If license is endorsed with a Class M, fee is $10.00.
No Fee. (update cards are not issued if requesting a change of Organ Donor designation status)
*ORGAN DONOR
When you are adding or removing the Organ Donor designation, the form must be notarized and a
replacement fee is required. Refer to fees above.
ORGAN DONATION
You have the opportunity to contribute $1.00 to the Fund. The additional $1.00 contribution must be added to
the fees above and included in your payment by check/money order. You must also check the block provided
AWARENESS TRUST FUND
in Section F to ensure proper handling of your contribution.
(ODTF)
CHANGE/CORRECTION
ONLY
NO FEE REQUIRED — The Bureau will issue an update card relecting the change/correction which must be carried with the driver’s license. Notarization is not required.
NAME CHANGE - If your name changed by permission of court, attach a Certiied Copy of the Court Order. If you desire to use a name other than your
(1) birth name, (2) spouse’s surname, or (3) a name given through a Court Order, you must provide a copy of your Social Security Card (or records), together with copies of documents from two other sources issued in the desired name such as: Tax Records, Selective Service Card, Voter Registration
Card, Passport, any form of Photo I.D. issued by a governmental agency, or state issued Birth Certiicate.
IF YEAR OF BIRTH on driver’s license is incorrect, attach a copy of your oficial birth certiicate.
IF Social Security Number is incorrect, attach copy of your Social Security Card.
PROVISIONS OF SECTION 3709 OF THE VEHICLE CODE
Section 3709 provides for a ine of up to $300 for dropping, throwing or depositing, upon any highway, or upon any other public or private property without the consent of the owner thereof or into or on the waters of this Commonwealth, from a vehicle, any waste paper, sweepings, ashes, household waste, glass, metal, refuse or rubbish or any dangerous or detrimental substance, or permitting any of the preceding without immediately removing such items or causing their removal.
For any violation of Section 3709, I may be subject to a ine of up to $300 upon conviction, including any violation resulting from the conduct of any other
persons present within any vehicle of which I am the driver.
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