Fill in a Valid Massachusetts Id Application Form

Emergency Contact Information: (optional)

C. Out of State Conversion (Skip if not converting from out of state)

D. Required Demographic Information

Military Status (documentation is required if checked – visit mass.gov/rmv for acceptable documents)

E. CDL Downgrade (if applicable)

CDL Downgrade: I understand that my CDL will be downgraded to a Class D, M, or D/M license and I authorize the RMV to process this transaction.

F. Voter Registration

To vote in Massachusetts you must be: A U.S. CITIZEN, a resident of Massachusetts and at least 18 years old on or before the next election in your city or town, which could be a town meeting, city or town preliminary, city or town election, state primary, state election, special state primary, special state election, or special city or town election.

•Check “Yes” if you want to register to vote, or you are changing your name or address and want to be registered to vote with this new information.

•If you answered “Yes,” complete question #2 and read the Affirmation Section below.

•Check “No” if you are currently registered to vote and do not want to change your voter registration.

Political Designation (not a political party) (Print desired designation): ___________________________________________________

PLEASE ASK THE LICENSE CLERK FOR YOUR VOTER REGISTRATION RECEIPT

AFFIRMATION TO BE READ BY APPLICANTS REGISTERING TO VOTE

I hereby swear (affirm) that I am the person named above, that the above information is true, that I AM A CITIZEN OF THE UNITED STATES, that I am at least 16 years old and I understand that I must be 18 years old to be eligible to vote, that I am not a person under a guardianship which prohibits my registering to vote, that I am not temporarily or permanently disqualified by law from voting because of corrupt practices in respect to elections, that I am not currently incarcerated for a felony conviction, and that I consider this residence to be my home. Signed under the penalty of perjury.

Confidentiality of voter registration information: If you register to vote, the office at which you submit your application will remain confidential and will be used only for voter registration purposes. If you decline to register to vote, the fact that you declined to register will remain confidential and will be used only for voter registration purposes.

Penalty for illegal voter registration: Fine of not more than $10,000 or imprisonment for not more than five years or both (M.G.L., Chap. 56, Section 8).

G. Mandatory Questions

H. Parent/Guardian Consent for Applicants under the age of 18

(Information & Certification of Person Providing Consent)

If the person giving consent IS NOT a parent, proper documentation of authority must be shown.

I hereby certify I am: (check one)  parent  legal guardian  Department of Children and Families  boarding school headmaster

of the above-named applicant who is less than 18 years of age, but not less than 16 years of age, if applying for a Learner’s Permit or Driver’s License OR who is less than 18 years of age, but not less than 14 years of age, if applying for an ID card, and that my consent is given as required by M.G.L. Chap. 90, Section 8 for the issuance of a Driver’s License; or as required by M.G.L. Chap. 90, Section 8B for a Learner’s Permit; or by M.G.L. Chap. 90, Section 8E for an Identification Card (ID). False certification is punishable by fine, imprisonment, or both (M.G.L. Chap. 90, Section 24B).

Parent/Guardian’s Address: ________________________________________________________________________________________________

Parent/Guardian’s Signature: _____________________________________________________________

I.Certification and Signature of Applicant (application not complete without signature)

I have reviewed this completed Application Form, including the Voter Registration Section, and hereby apply for a Learner’s Permit/Driver’s License or an ID card and swear (affirm), under the penalties of perjury, that the information I have provided is true and correct.

I am aware that false statements are punishable by fine, imprisonment, or both under M.G.L. Chapter 90, Section 24B.

Signature: __________________________________________________________ Date: _________________________

The Registrar reserves the right to cancel, revoke, or recall, any learner’s permit, driver’s license, or ID card if it is determined that the applicant was not qualified for such learner’s permit, driver’s license, or ID card.

RMV Use Only

Date: __________________________ Clerk Initials: _________________