Application Form

Application for International Driving Permit or
Inter-American Driving Permit

Issuance of Permit is restricted to persons EIGHTEEN YEARS or over who hold a valid U.S.A. or Territorial License.
PERMIT VALID FOR ONE YEAR. Not renewable.

CHECK DESIRED PERMIT TYPE

____   International Driving Permit
(Fee and 2 Passport Type Photos signed on back)
_____ Inter-American Driving Permit
(Fee and 2 Passport Type Photos signed on back)
MANDATORY REQUIREMENTS
(1) Attach 2 recent signed Passport Type Photos (2″ X 2″) (2) Enclose permit fee

Mr. Mrs. Ms. (Circle One)

PRINT NAME IN FULL. No Initials

First Middle Last
Phone

 

Home Street Address

 

City State Zip Code
U.S. Driver’s License No.

 

State of Issue

 

Expiration Date

 

Birthplace: City

 

State or Country

 

Birth Date (Mo. Day Year)

 

Date Permit to be Effective

 

Departure Date From U.S.

 

Foreign Address (if known)

PLEASE CHECK THE APPROPRIATE BOX BELOW TO INDICATE THE TYPE OF VEHICLE YOU NOW HOLD A VALID U.S.A. OR TERRITORIAL DRIVER’S LICENSE, AND FOR WHICH YOU DESIRE THIS PERMIT:
___ MOTORCYCLE                    ___ PASSENGER CAR
___ VEHICLE OVER 7,700 LBS.  ___ VEHICLE WITH HEAVY TRAILER

I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT, AND THAT THE LICENSE INDICATED HAS NOT BEEN SUSPENDED NOR REVOKED.

I FURTHER CERTIFY THAT I UNDERSTAND THAT A VALID STATE DRIVER’S LICENSE MUST ACCOMPANY THIS PERMIT, AND THAT THIS PERMIT IS VALID ONLY AS LONG AS THE STATE LICENSE IS VALID, BUT NOT TO EXCEED ONE YEAR FROM THE DATE THE PERMIT ISSUED.

 

SIGNATURE (signature mandatory for Issuance of Permit)

 

DATE

 

 

THIS IS YOUR MAILING LABEL
Please print to ensure prompt delivery