DL-143 (12-21)

NON-COMMERCIAL DRIVER'S LICENSE

APPLICATION FOR RENEWAL
DO NOT Renew if license is under suspension and you have recently surrendered it. Bureau of Driver Licensing, P.O. Box 68272, Harrisburg, PA 17106-8272

A DRIVER'S LICENSE NUMBER LAST NAME JR./ETC

FIRST NAME MIDDLE NAME

DATE OF BIRTH TELEPHONE NUMBER (8:00 A.M.-4:30 P.M.) E-MAIL ADDRESS (if applicable)
Month Day Year

B CHANGE OR CORRECTION ONLY (Important information on reverse side)

ADDRESS -  A Post Office 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.
STREET ADDRESS

PA
CITY STATE ZIP CODE

This application will also serve as a request to update your voter registration unless you check this box:
If you are not registered to vote, you will receive an application to register. You must be a U.S. citizen to register to vote in Pennsylvania.

NAME CHANGE (Please note all name changes must be done in person with original documents) REASON: MARRIAGE    DIVORCE   OTHER (see reverse side)
LAST NAME JR., ETC. FIRST NAME MIDDLE NAME

OTHER CHANGES
EYE COLOR (Please check one):        BLUE    BROWN    GREEN      HAZEL     PINK     BLACK     GRAY      DICHROMATIC    OTHER_______________________

ADD LENS RESTRICTION OR REMOVE LENS RESTRICTION - (Please Note: Must include DL-102 Application completed by Health Care Provider)

CORRECTION OF DATE OF BIRTH HEIGHT SOCIAL SECURITY NUMBER DROP PRIVILEGE:

MONTH DAY YEAR FEET INCHES
Drop Class M

C 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 Center
to surrender your out-of-state license and complete an application for a PA License.

1.  YES   NO - Do you hold a valid driver's license issued by any other state?
ALL MUST BE ANSWERED

If yes, give: State ___________  Expiration Date_________________________________

Driver's License No.________________________________________________________
2.  YES NO - Is your driver's license or driving privilege suspended or revoked in this state or any other state?
3.  YES NO - Do you have any pending criminal charges or driving violations in this state or any other state which may carry a possible penalty of suspension
or revocation of your driver's license or driving privilege?

If yes, give state_____________  Date________________  and Reason _________________________________________________________________________

Out-of-State Address/Photo Exemption - If requesting an out of state address or photo exemption you must complete an Out-Of-State Address/Photo Exemption Form
(DL-82) and submit along with this form. NOTE: For Photo Exemption, you must be out of state for the entire next 60 days.

D AUTHORIZATION AND CERTIFICATION (Sign and Enter Fee)

For Veterans wishing to add the Veterans Designation to their Driver's License or ID Card: I certify under penalty of law that I am a qualified applicant and hereby request it
be added to my product. I understand that misrepresentation will result in the cancellation of my driver's license.
I acknowledge that receiving a Pennsylvania Permit, License or ID card will cancel or invalidate any Permit, License or ID card from another state. I certify under
penalty of law that all information given on this application is true and correct. I hereby authorize the Social Security Administration to release to the Department of Transportation
information concerning my Social Security Identification Number for the purpose of identification. If using a Messenger Service, I hereby authorize the Department to furnish them
with my driving record for the purpose of processing this form. I hereby acknowledge this day that I have received notice of the provisions of Section 3709 of the Vehicle Code.
(See reverse for provisions.)
I wish to contribute $3.00 to the Organ Donation Awareness Trust Fund. If checked here, include the additional $3.00 in the amount entered in the Fee Paid block. (see reverse)

I wish to contribute $3.00 to the Veterans' Trust Fund. (see reverse)

X
SIGN
HERE
APPLICANT'S SIGNATURE IN INK DATE
WARNING: Misstatement of Fact is a misdemeanor of the third degree punishable by a fine of up to $2,500 and/or imprisonment up to 1 year (18 Pa. C.S. Section 4904[b]).

Payable to PennDOT (PennDOT Driver License

PAID BY: Debit/Credit Card Check Money Order TOTAL $
Centers do not accept cash.)
DL-143 (12-21)

The most current version of this form can be found at: www.dmv.pa.gov

Out-of-State Address/Photo Exemption - If requesting an out of state address or photo exemption you must complete an Out-Of-State Address/Photo
Exemption Form (DL-82) and submit along with this form. NOTE: For Photo Exemption, you must be out of state for the entire next 60 days.

INSTRUCTIONS
• Veterans Designation: You have the opportunity to add the veterans designation to your driver's license, which clearly indicates you
are a veteran of the United States Armed Forces. To qualify, you must have served in the United States Armed Forces, including a reserve
component or the National Guard, and have been discharged or released from such service under conditions other than dishonorable. If you
are requesting to add the veterans designation to your license/ID card, make sure you check the box at the top in Section D.
• COMPLETE sections A, B (if applicable), C, and D.
• Return your completed and signed application, along with your check or money order payable to "PennDOT", to the: Bureau of Driver
Licensing, P.O. Box 68272, Harrisburg, PA 17106-8272.

FEE INFORMATION
RENEWAL OF A 4 YEAR FEE: $30.50 - 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
NON-COMMERCIAL
for the purpose of having a photo taken.
DRIVER’S LICENSE
If license is endorsed with Class M, fee is $50.50.

RENEWAL OF A 2 YEAR FEE: $20.00 - The Bureau will issue a camera card, which is a temporary Non-Commercial Driver’s
NON-COMMERCIAL License valid for 60 days. During those 60 days, the driver must appear at a photo driver license center
for the purpose of having a photo taken. If license is endorsed with Class M, fee is $30.00.
DRIVER’S LICENSE
NOTE: Drivers age 65 and over have the option of requesting a two (2) year driver's license.
ORGAN DONATION You have the opportunity to contribute $3.00 to the Fund. The additional $3.00 contribution must be
AWARENESS TRUST added to the fees above and included in your payment by check/money order. You must also check the
FUND (ODTF) block provided in Section F to ensure proper handling of your contribution.

You have the opportunity to make a tax deductible contribution to the VTF. Your contribution will help
VETERANS’ TRUST support programs and projects for pennsylvania veterans and their families. Since this additional $3.00
FUND (VTF) is not part of the fee, please add the donated amount to your payment. Also, please check the proper
block on the form to ensure your contribution is handled properly.

CHANGE/CORRECTION NO FEE REQUIRED — The Bureau will issue an update card reflecting the change/correction which must
ONLY be carried with the Pennsylvania Identification Card. Notarization is not required.

NAME CHANGE - If you desire to use your birth name, you must present your state issued birth certificate with a raised seal. If your name
changed by permission of court, you must present a Certified Copy of the Court Order. If you desire to use your spouse’s surname, you
must present your marriage certificate. If you desire to use another name, you must present your Social Security Card, together with 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, banking records, or baptismal certificate.
To report errors on your driver’s license relating to name, date of birth or social security number, please contact PennDOT’s
Customer Care Center at 717-412-5300. TTY callers - please dial 711 to reach us.
If you are required to present supporting documentation to correct your record, all documents must be originals and
presented in person at a PennDOT Driver License Center.
· For NAME corrections, you must present your state issued birth certificate with a raised seal, a Certified Copy of the Court
Order or your marriage certificate.
· For DATE OF BIRTH corrections, you must present state issued birth certificate with raised seal.
· For SOCIAL SECURITY NUMBER corrections, you must present your Social Security Card.
*Note: All name changes must be made in person at a Driver License Center. All documents must be original.

GENDER CHANGE - If requesting a gender change, a DL-32 (Request for Gender Designation Change) application must be completed
along with this application and submitted in person to a Driver License Center for processing.

Change your address or renew your driver's license online at www.dmv.pa.gov

PROVISIONS OF SECTION 3709 OF THE VEHICLE CODE

Section 3709 provides for a fine 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 fine 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.