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Get DL-43 Form in PDF

The DL-43 form is an essential document used in various legal and administrative processes, particularly concerning the application for a driver's license in specific jurisdictions. Understanding its purpose and the information it requires can streamline the licensing process for individuals. This article will explore the significance of the DL-43 form and provide insights into its completion and submission.

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The DL-43 form is an essential document for individuals seeking to obtain a Pennsylvania driver's license or identification card. This form serves as a critical part of the application process, ensuring that applicants provide the necessary information to verify their identity and residency. It encompasses various details, including personal information such as name, address, date of birth, and social security number. Additionally, the DL-43 form requires applicants to disclose their driving history, which may include any prior licenses held and any violations that could impact their eligibility. Understanding the significance of this form is crucial, as it not only facilitates the issuance of a driver's license but also helps maintain the integrity of the state's driving records. Completing the DL-43 accurately and thoroughly can streamline the application process, making it smoother for those looking to hit the road legally and safely.

Dos and Don'ts

When filling out the DL-43 form, it’s essential to follow certain guidelines to ensure a smooth process. Here are some important do's and don'ts to keep in mind:

Do read the instructions carefully before starting.
Don't leave any required fields blank.
Do use clear and legible handwriting if filling out the form by hand.
Don't use correction fluid or tape on the form.
Do double-check your information for accuracy.
Don't submit the form without signing it.
Do keep a copy of the completed form for your records.
Don't forget to include any necessary supporting documents.
Do pay attention to the submission deadlines.

Following these guidelines will help you avoid common pitfalls and ensure your DL-43 form is processed efficiently.

Document Attributes

Fact Name	Description
Purpose	The DL-43 form is used for applying for a replacement or duplicate driver’s license in various states.
Eligibility	Individuals must be a licensed driver in the state where they are applying for the DL-43 form.
Governing Law	In Pennsylvania, the governing law for the DL-43 form falls under Title 75 of the Pennsylvania Consolidated Statutes.
Submission Method	The form can often be submitted online, by mail, or in person at designated Department of Motor Vehicles (DMV) offices.
Fees	There is typically a fee associated with the issuance of a replacement license, which varies by state.

Key takeaways

The DL-43 form is an important document for individuals seeking to obtain or renew a Pennsylvania driver's license. Here are some key takeaways regarding its use:

The DL-43 form is specifically designed for non-U.S. citizens applying for a driver's license in Pennsylvania.
Ensure all personal information is accurate and complete to avoid delays in processing.
Gather necessary supporting documents, such as proof of identity and residency, before filling out the form.
Use black or blue ink when completing the form to ensure clarity and readability.
Sign and date the form where indicated; an unsigned form will be rejected.
Double-check for any specific instructions provided on the form itself, as they may vary.
Submit the completed DL-43 form in person at a PennDOT driver license center.
Keep a copy of the submitted form for your records, as it may be needed for future reference.
Be aware of any fees associated with the application process, and prepare for payment when submitting the form.

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Example - DL-43 Form

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

Detailed Instructions for Writing DL-43

Filling out the DL-43 form is an important step in the process you are undertaking. It is essential to provide accurate information to ensure everything goes smoothly. Follow these steps to complete the form correctly.

Begin by gathering all necessary personal information, such as your full name, date of birth, and address.
Locate the DL-43 form, either online or at your local DMV office.
Carefully read the instructions provided with the form to understand what is required.
Fill in your personal details in the designated fields. Make sure to double-check for any typos or errors.
Provide any additional information requested, such as your Social Security number or identification details.
If applicable, sign and date the form at the bottom. Ensure your signature matches the one on your ID.
Review the completed form to confirm that all information is accurate and complete.
Submit the form according to the instructions, either online, by mail, or in person at your local DMV.

Documents used along the form

The DL-43 form is a crucial document for individuals seeking to apply for or renew a driver's license in the United States. Alongside this form, several other documents may be required to ensure a smooth application process. Each of these forms serves a specific purpose, providing essential information to the authorities responsible for issuing licenses.

Proof of Identity: This document verifies the applicant's identity. It can include a birth certificate, passport, or any government-issued ID that includes a photo. Such proof is vital to confirm that the individual is who they claim to be.
Proof of Residency: Applicants must provide evidence of their current address. This may take the form of utility bills, lease agreements, or bank statements. Establishing residency is a key requirement for obtaining a driver's license in many states.
Rental Application Form: Completing a NY Templates is crucial for landlords to gather essential information from prospective tenants effectively.
Social Security Number (SSN) Verification: This document ensures that the applicant's Social Security number is valid and corresponds to their identity. Typically, a Social Security card or tax documents can be submitted for this purpose.
Medical Certification: In some cases, applicants may need to submit a medical certification form. This document confirms that the individual meets the health requirements necessary for safe driving. It may be particularly relevant for those with specific medical conditions that could affect their ability to operate a vehicle.

In summary, when applying for or renewing a driver's license, the DL-43 form is often accompanied by several other important documents. Each serves a distinct role in verifying identity, residency, and eligibility, thus facilitating a comprehensive review process by the issuing authority.