Blank DL-43 Form

The DL-43 form is a crucial document used in the process of applying for a Pennsylvania driver's license or identification card. This form collects essential information from applicants to ensure compliance with state regulations. Understanding its requirements and purpose is vital for anyone navigating the licensing process in Pennsylvania.

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Structure

Misconceptions

The DL-43 form is often misunderstood. Here are ten common misconceptions about it, along with clarifications.

It is only for driver's license renewals.
The DL-43 form can also be used for applying for a new license, not just renewals.
Only residents can use the DL-43 form.
Non-residents may also be eligible to use this form under certain conditions.
You need to submit it in person.
While many choose to submit the form in person, some states allow online submissions.
It requires a lot of complicated information.
The form is designed to be straightforward and asks for basic personal details.
It can be filled out in any language.
The DL-43 form must be completed in English, as it is the official language for processing.
There are no fees associated with the DL-43 form.
Fees may apply depending on the state and the specific service requested.
Submitting the form guarantees a new license.
Approval is not guaranteed; it depends on meeting all requirements and passing any necessary tests.
Once submitted, you cannot make changes.
In many cases, you can request changes before the application is processed.
The DL-43 form is only for adults.
Minors can also use this form, but additional documentation may be needed.
You must have a Social Security number to apply.
While a Social Security number is often required, some applicants may qualify for exceptions.

Detailed Steps for Filling Out DL-43

Filling out the DL-43 form is a straightforward process that requires careful attention to detail. This form is essential for specific administrative purposes, and completing it accurately will help ensure that your application proceeds smoothly.

Begin by gathering all necessary personal information, including your full name, address, and date of birth.
Obtain the DL-43 form from the appropriate source, such as a government website or local office.
Carefully read the instructions provided with the form to understand each section.
Fill in your personal information in the designated fields. Ensure that all entries are legible and accurate.
Provide any required identification numbers, such as your Social Security number or driver's license number, if applicable.
Answer all questions on the form truthfully. If a question does not apply to you, indicate that clearly, often by marking "N/A."
Review your completed form for any errors or omissions before submitting it.
Sign and date the form where indicated, confirming that all information is correct to the best of your knowledge.
Submit the form according to the instructions provided, whether by mail or in person.

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APPLICATION FOR RENEWAL/REPLACEMENT/CHANGE

(Replacement also called Duplicate)

OF A TEXAS DRIVER LICENSE OR IDENTIFICATION CARD

DL or ID NUMBER

APPLICANT INFORMATION

CONTACT INFORMATION

LAST NAME:

HOME PHONE:

FIRST NAME:

OTHER PHONE:

MIDDLE NAME:

EMAIL:

SUFFIX:

ADDRESS INFORMATION

MAIDEN NAME:

RESIDENCE ADDRESS:

DATE OF BIRTH (mm/dd/yyyy):

—

CITY:

STATE:

SSN:

—

ZIP CODE:

COUNTY:

SEX: (Mark One)

MALE

FEMALE

WEIGHT: lbs.

MAILING ADDRESS:

EYE COLOR:

HEIGHT: ft.

in.

RACE/ETHNICITY:

(I)

American Indian/Alaska

Native

CITY:

STATE:

(A) Asian/Pacific Islander

(B) Black (H) Hispanic (O) Other

(W) White

ZIP CODE:

COUNTY:

INFORMATION FORM (ALL APPLICANTS please answer questions 1 through 10)

1. YES NO

Are you a citizen of the United States?

If you are a US citizen, would you like to register to vote? If registered, would you like to update your voter information?

By providing my electronic signature, I understand the personal information on my application form and my electronic signature will be used for submitting

my voter’s registration application to the Texas Secretary of State’s office. Wanting to register to vote, I authorize the Department of Public Safety to

transfer this information to the Texas Secretary of State.

Do you wish to donate $1.00 to the Blindness Education Screening and Treatment Program?

Do you want to support the Glenda Dawson Donate Life Texas donor registry? If yes, please indicate a donation amount of $1 or more $

.00

Would you like to register as an organ donor?

Do you want to support survivors of sexual assault? If yes, please indicate a donation amount of $1 or more $

.00 to help fund the testing

of sexual assault evidence collection kits (rape kits).

.00

Do you want to support Texas Veterans?

If yes, please indicate your donation amount $

Do you have a health condition that may impede communication with a peace officer? If yes, please list

(physician must complete form DL-101 prior to the issuance of a DL/ID).

a) Do you want a Veteran designator on your driver license or identification card?

(proof of Honorable discharge required; acceptable documents

are DD214/5, NGB22, VA disability letter, proof of service/verification of honorable service card)

10.

Are you a 60% disabled Veteran receiving compensation and want to waive the application fee? (see 9a for documents required)

In the event of injury or death would you like to provide two (2) emergency contacts? If yes, please list:

Name

Telephone Number

Address

Name

Telephone Number

Address

For all Driver License Renewals complete MEDICAL questions 11 to 17. Answers to the questions below are for the confidential use of the Department.

11.

Do you currently have or have you ever been diagnosed with or treated for any medical condition that may affect your ability to safely operate a

motor vehicle?

Examples, including but not limited to: Diagnosis or treatment for heart trouble, stroke, hemorrhage or clots, high blood pressure, emphysema (within past two years)

 progressive eye disorder or injury (i.e., glaucoma, macular degeneration, etc.)  loss of normal use of hand, arm, foot or leg  blackouts, seizures, loss of consciousness

or body control (within the past two years) 

difficulty turning head from side to side

 loss of muscular control  stiff joints or neck  inadequate hand/eye

coordination  medical condition that affects your judgment  dizziness or balance problems

 missing limbs

If you answered YES above, has your condition

IMPROVED or

DETERIORATED since your last application for an original/renewal remake of your driver license?

12.

Do you have a mental condition that may affect your ability to safely operate a motor vehicle?

If yes, please explain:

13.

Have you ever had an epileptic seizure, convulsion, loss of consciousness, or other seizure?

14.

Do you have diabetes requiring treatment by insulin?

15.

Do you have any alcohol or drug dependencies that may affect your ability to safely operate a motor vehicle or have you had any episodes

16.

of alcohol or drug abuse within the past two years?

Within the past two years, have you been treated for any other serious medical conditions?

17.

Explain:

Have you EVER been referred to the Texas Medical Advisory Board for Driver Licensing?

Any male United States citizen or immigrant who is at least 18 years of age but less than 26 years of age submitting this application consents to registration with the

United States Selective Service System. You must be registered to qualify for federal student aid (to include Pell grant), job training, federal employment, and citizenship

if an immigrant. In Texas, you must be registered to qualify for state college student aid or state employment. If convicted, failure to register with the Selective Service is

a felony punishable by up to five years in prison and/or a $250,000 fine. If not registered by age 26, you can no longer register and could permanently lose those benefits

associated with registration. For alternative options for applicants who object to conventional military service for religious or other conscientious reasons information is

available at: http://www.sss.gov/FactSheets/FSaltsvc.pdf.

I do solemnly swear, affirm, or certify that I am the person named herein and that the statements on this information form are true and correct. I further certify my resi-

dence address is a (check 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.

DL-43 (Rev. 1/18)

SIGNATURE OF APPLICANT

DATE

SOLICITUD PARA RENOVAR, REEMPLAZAR, Ó HACER

(El reemplazo también es llamado duplicado)

CAMBIOS EN LA LICENCIA DE CONDUCIR O TARJETA DE

NUMERO DE LICENCIA O DE TARJETA DE IDENTIFICACIÓN:

IDENTIFICACIÓN DEL ESTADO DE TEXAS

INFORMACIÓN DEL SOLICITANTE

INFORMACIÓN DE CONTACTO

APELLIDO:

NÚMERO DE TELÉFONO:

PRIMER NOMBRE:

TELÉFONO SECUNDARIO:

SEGUNDO NOMBRE:

CORREO ELECTRÓNICO:

SUFIJO:

SU DOMICILIO

APELLIDO DE SOLTERA:

DOMICILIO DONDE RESIDE:

FECHA DE NACIMIENTO (mm/dd/aaaa):

CIUDAD:

ESTADO:

NÚMERO DE SEGURO SOCIAL:

—

CÓDIGO POSTAL:

CONDADO:

SEXO: (Marque uno)

HOMBRE

MUJER

PESO: en libres.

DOMICILIO POSTAL (Lugar donde recibe su correspondencia):

COLOR DE LOS OJOS:

ESTATURA: pies

pulg.

RAZA/ETNIA:

(I) Amerindio/Nativo de Alaska

(A) Asiático/nativo

CIUDAD:

ESTADO:

de las Islas del Pacífico (B) Negro (H) Hispano (O) Otro (W) Blanco

CÓDIGO POSTAL:

CONDADO:

INFORMACIÓN SOBRE EL SOLICITANTE (TODOS LOS SOLICITANTES favor de contestar las preguntas 1 a 10)

SI NO

¿Es usted ciudadano de los Estados Unidos?

Si usted es ciudadano de los Estados Unidos, ¿le gustaría registrarse para votar? Si ya está registrado, ¿le gustaría actualizar su información de votante?

Al proporcionar mi firma electrónica, comprendo que la información personal en mi solicitud, junto con mi firma electrónica, se usará para enviar mi

solicitud de registro electoral a la oficina de la Secretaría del Estado de Texas. Deseo registrarme para votar; por lo tanto, autorizo al Departamento

de Seguridad Pública para transferir esta información a la Secretaría del Estado de Texas.

¿Desea usted donar $1.00 al Programa de Educación, Evaluación y Tratamiento de la Ceguera?

¿Desea apoyar el Programa de Registro de Texas-Glenda Dawson Donar Vida? En caso afirmativo, indicar una cantidad de la donación

de $1 o más $

.00

¿Desea registrarse como donador de órganos?

¿Quieres apoyar a los sobrevivientes de asalto sexual? Si es así, porfavor indique la cantidad de donación de $1 o más $

.00 para

ayudar a financiar la recopilación de evidencia de asalto sexual (kit de violación)

.00

¿Desea apoyar los Veteranos de Texas? Si la respuesta es sí, por favor, indique la cantidad de su donación $

¿Tiene usted alguna afección médica que le pueda impedir la comunicación con un oficial de la policía? En caso afirmativo, por favor indique

(el médico debe llenar el formulario DL-101 antes de emitir una licencia de conducir o tarjeta de identificación).

a) Desea una insignia de Veterano en su licencia de conducir o su tarjeta de identificación? (Se requiere comprobante de baja honorable; los

documentos aceptables son DD214/5, NGB22, carta de discapacidad del VA, prueba de servicio/verificación de la tarjeta de servicio honorable)

¿Es usted un Veterano que recibe 60% de compensación por discapacidad y desea quedar exento de los derechos de solicitud?

10.

(vea el punto 9a para conocer qué documentos se requieren).

En caso afirmativo, por favor indique:

En caso de sufrir lesiones o la muerte, ¿le gustaría proporcionar dos (2) contactos para emergencias?

Nombre

Número telefónico

Domicilio

Nombre

Número telefónico

Domicilio

Para todas las Renovaciones de Licencia de Conducir, complete las preguntas MÉDICAS 11 a 17.

Las respuestas a las siguientes preguntas son para uso confidencial del Departamento.

11.

¿Tiene actualmente o alguna vez ha sido diagnosticado con o tratado por alguna enfermedad que pueda afectar su capacidad de

operar un vehículo motorizado de manera segura?

Ejemplos, incluyendo pero no limitado a: Diagnóstico o tratamiento por problemas cardíacos, derrame cerebral, hemorragia o coágulos, presión arterial alta, enfisema (en los últi-

mos dos años)  enfermedad progresiva o lesión de la vista (como glaucoma, degeneración macular, etc.)  pérdida del uso normal de la mano, brazo, pie o pierna  desvanec-

imientos, ataques, pérdida de la consciencia o control del cuerpo (en los últimos dos años)

 dificultad para voltear la cabeza de un lado a otro

 pérdida de control muscular  artic-

ulaciones o cuello rígidos  coordinación inadecuada de mano/ojo  afección médica que altere su juicio  mareos o problemas de equilibrio  pérdida de algún miembro

Si respondió SÍ a la pregunta anterior, ¿su afección ha

MEJORADO o

EMPEORADO desde su última solicitud de original/renovación de licencia de conducir?

12.

¿Tiene usted un condición mental que puede afectar su capacidad para operar con seguridad un vehículo motorizado? Si su respuesta es si,

13.

por favor de explicar:

¿Alguna vez ha tenido un ataque epiléptico, convulsión, pérdida de la consciencia u otro ataque?

14.

¿Tiene diabetes que requiera tratamiento con insulina?

15.

¿Tiene alguna dependencia del alcohol o de drogas que pudiera afectar su capacidad de operar un vehículo motorizado de manera

16.

segura o ha tenido algún episodio de abuso de drogas o alcohol en los últimos dos años?

En los últimos dos años, ¿ha recibido tratamiento por alguna otra afección médica grave?

17.

Explique:

¿Alguna vez ha sido remitido al Comité Asesor Médico de Licencias de Conducir de Texas?

Cualquier hombre ciudadano o inmigrante de los Estados Unidos entre 18 y 26 años de edad que presente esta solicitud otorga su consentimiento para ser registrado

en el Sistema de Servicio Militar Selectivo de los Estados Unidos. Usted debe estar registrado para tener derecho a recibir ayuda federal estudiantil (incluso la beca

Pell Grant), capacitación laboral, empleo federal y la ciudadanía si es inmigrante,. En Texas, usted debe estar registrado para tener derecho a recibir ayuda estudiantil

universitaria o empleo con el Estado. No registrarse en el Servicio Militar Selectivo es un delito mayor. Si es declarado culpable de ello, podría ser castigado hasta con

cinco años de prisión y/o una multa de 250,000 dólares. Si no se ha registrado antes de cumplir 26 años, ya no se podrá registrar y podría perder permanentemente los

beneficios asociados con el registro. Para conocer otras opciones alternativas para solicitantes que se oponen al servicio militar convencional por motivos religiosos u otros

motivos de conciencia, podrá encontrar información disponible en: http://www.sss.gov/FactSheets/FSaltsvc.pdf.

Juro solemnemente, afirmo o certifico que soy la persona que se indica en el presente documento y que las declaraciones en esta solicitud son verdaderas y correctas. Además

certifico que mi domicilio de residencia es (marque una opción): (

) casa residencial, (

) apartamento, ( ) hotel, ( ) sitio de refugio temporal. Estoy de acuerdo en informar

inmediatamente al Departamento de Seguridad Pública de Texas cualquier cambio en mi condición médica que pueda afectar mi capacidad para conducir de manera segura

un vehículo motorizado.

DL-43 (Rev. 1/18)

FIRMA DEL ASPIRANTE

FECHA

Common PDF Templates

High School Transcript - School counselors often assist students with understanding and utilizing their transcripts effectively.

Usacc Form 112 - Signatures from both the student and an institution official are mandatory.

How Many Pages in a Passport - Make sure the passport photo is taken within six months of your application.

Dos and Don'ts

When filling out the DL-43 form, it's important to follow certain guidelines to ensure the process goes smoothly. Here are five things you should and shouldn't do:

Do read the instructions carefully before starting.
Do use black or blue ink to fill out the form.
Do provide accurate and complete information.
Do double-check your entries for any mistakes.
Do sign and date the form where required.

Don't leave any required fields blank.
Don't use white-out or correction fluid on the form.
Don't submit the form without reviewing it first.
Don't forget to include any necessary supporting documents.
Don't rush through the process; take your time to ensure accuracy.

Key takeaways

The DL-43 form is essential for certain applications related to driver licenses and identification cards. Here are some key takeaways to keep in mind when filling it out and using it:

Ensure that you have the most recent version of the DL-43 form. Using an outdated version can lead to delays or rejections.
Fill out the form completely and accurately. Incomplete or incorrect information may result in processing issues.
Double-check your personal information, including your name, address, and date of birth. Errors can cause significant complications.
Provide any required documentation as specified on the form. Missing documents can hinder your application.
Sign and date the form where indicated. An unsigned form is not valid and will be returned.
Submit the form according to the instructions provided. Whether online or in person, follow the specified submission guidelines.
Keep a copy of the completed DL-43 form for your records. This can be helpful if any issues arise later.
Be aware of any fees associated with the application process. Ensure payment is made as instructed to avoid delays.
Check the status of your application if you do not receive confirmation within the expected timeframe. Staying proactive can help resolve issues quickly.

Similar forms

The DL-43 form is similar to the Form I-9, which is used for employment eligibility verification in the United States. Both forms require personal information and verification of identity. The I-9 form requires employees to provide documents that establish identity and employment authorization, while the DL-43 focuses on personal identification for driver’s license or identification card purposes. Each form serves to confirm identity but is used in different contexts—employment versus driving privileges.

Another comparable document is the Form DS-11, used for applying for a U.S. passport. Like the DL-43, the DS-11 requires applicants to provide personal information, proof of identity, and citizenship. Both forms are critical for establishing identity in official capacities. However, the DS-11 focuses on international travel, while the DL-43 is more focused on state identification for driving and other local purposes.

The Social Security Administration's Form SS-5 is also similar to the DL-43. This form is used to apply for a Social Security card. Both documents require the submission of personal information and proof of identity. The SS-5 form is specifically aimed at establishing eligibility for Social Security benefits, while the DL-43 is aimed at obtaining a state-issued driver’s license or ID card.

The Voter Registration Form is another document that shares similarities with the DL-43. Both forms require individuals to provide personal information to verify identity. The Voter Registration Form is specifically designed to register individuals to vote, while the DL-43 serves to provide identification for driving and other state services. Each form plays a role in civic participation and identity verification.

The Form 1040, used for filing federal income tax returns, also bears resemblance to the DL-43. Both forms collect personal information and require accurate reporting of identity details. The 1040 form is focused on financial information and tax obligations, whereas the DL-43 is centered around identification for driving purposes. Each form is essential for compliance with U.S. regulations in their respective areas.

The Form N-400, Application for Naturalization, is another document similar to the DL-43. Both require detailed personal information and documentation to verify identity. The N-400 is used by immigrants seeking U.S. citizenship, while the DL-43 is for obtaining a driver’s license or ID. Each form serves as a gateway to accessing rights and privileges within the United States.

Lastly, the Form 4506-T, Request for Transcript of Tax Return, shares similarities with the DL-43. Both documents require personal information and are used to verify identity. The 4506-T form is specifically for obtaining tax return information, which may be necessary for various financial processes, while the DL-43 is used for identification related to driving. Each form is essential in its respective context for identity verification.

Documents used along the form

The DL-43 form is an important document often used in the context of driver's license applications and renewals. However, it is typically accompanied by several other forms and documents that help streamline the process and ensure compliance with state regulations. Below is a list of commonly used forms that you may encounter alongside the DL-43.

Proof of Identity: This document verifies your identity and may include a passport, birth certificate, or other government-issued ID. It is essential for establishing who you are when applying for a driver's license.
Proof of Residency: To confirm your address, you might need to provide a utility bill, lease agreement, or bank statement. This helps the Department of Motor Vehicles (DMV) ensure that you reside in the state where you are applying for a license.
Medical Certification: Depending on your health and age, you may be required to submit a medical certification form. This document confirms that you meet the necessary health standards to drive safely.
Vision Test Results: A vision test is often required to ensure that you can see well enough to drive. You may need to submit the results from a recent eye exam or complete a vision screening at the DMV.

By preparing these additional documents, you can help facilitate a smoother application process for your driver's license. Having everything in order not only saves time but also reduces the likelihood of delays or complications during your visit to the DMV.