The DL-43 form is an important document used in the state of Pennsylvania for individuals seeking to apply for or renew a driver's license or identification card. This form collects essential personal information and verifies eligibility for licensing. Understanding the DL-43 form is crucial for a smooth application process.
The DL-43 form plays a crucial role in the realm of driver licensing in the United States, particularly for individuals seeking to obtain or renew their commercial driver's license (CDL). This form is essential for ensuring that applicants meet the necessary qualifications and standards set forth by state and federal regulations. It typically requires detailed personal information, including the applicant's name, address, and date of birth, as well as specific data related to their driving history and medical fitness. Additionally, the DL-43 form serves as a declaration of the applicant's compliance with various legal requirements, such as passing a vision test and meeting age restrictions. Understanding the intricacies of this form can significantly impact the licensing process, making it vital for prospective drivers to approach it with care and attention. Completing the DL-43 accurately can streamline the application process, while errors or omissions may lead to delays or complications. Ultimately, this form is not just a bureaucratic hurdle; it is a key component in maintaining road safety and ensuring that only qualified individuals are entrusted with the responsibility of operating commercial vehicles.
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
(A) Asian/Pacific Islander
(B) Black (H) Hispanic (O) Other
(W) White
INFORMATION FORM (ALL APPLICANTS please answer questions 1 through 10)
1. YES NO
Are you a citizen of the United States?
2.
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
3.
transfer this information to the Texas Secretary of State.
Do you wish to donate $1.00 to the Blindness Education Screening and Treatment Program?
4.
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
5.
Would you like to register as an organ donor?
6.
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
7.
of sexual assault evidence collection kits (rape kits).
Do you want to support Texas Veterans?
If yes, please indicate your donation amount $
8.
Do you have a health condition that may impede communication with a peace officer? If yes, please list
9.
(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
b)
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:
a)
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
de las Islas del Pacífico (B) Negro (H) Hispano (O) Otro (W) Blanco
INFORMACIÓN SOBRE EL SOLICITANTE (TODOS LOS SOLICITANTES favor de contestar las preguntas 1 a 10)
1.
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 $
¿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)
¿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?
(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
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.
¿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?
¿Tiene usted un condición mental que puede afectar su capacidad para operar con seguridad un vehículo motorizado? Si su respuesta es si,
por favor de explicar:
¿Alguna vez ha tenido un ataque epiléptico, convulsión, pérdida de la consciencia u otro ataque?
¿Tiene diabetes que requiera tratamiento con insulina?
¿Tiene alguna dependencia del alcohol o de drogas que pudiera afectar su capacidad de operar un vehículo motorizado de manera
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?
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.
FIRMA DEL ASPIRANTE
FECHA
The DL-43 form is commonly used for various purposes related to driver's licenses and identification in the United States. When completing the DL-43 form, you may also need to submit additional documents to support your application or request. Below is a list of other forms and documents that are often used in conjunction with the DL-43 form.
Gathering these documents will help ensure a smooth application process when submitting the DL-43 form. Each document serves a specific purpose and may be necessary depending on your individual circumstances.
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Panel Schedule - The form facilitates communication regarding electrical layout among technicians.
The DL-43 form is an important document used for various purposes, primarily related to obtaining a driver's license in certain states. Here are some key takeaways to keep in mind when filling out and using this form:
The DL-43 form is a document used in various states for specific purposes, often related to driver's license applications or renewals. It typically serves to collect necessary personal information and verify identity. While the exact purpose can vary by state, it is crucial for individuals seeking to obtain or renew their driver's licenses.
Individuals applying for a new driver's license, renewing an existing license, or making changes to their current license may need to complete the DL-43 form. This includes first-time drivers, those who have moved to a new state, or anyone who has had a significant change in personal circumstances, such as a name change.
The DL-43 form can usually be obtained from your state’s Department of Motor Vehicles (DMV) website. Many states provide a downloadable PDF version of the form. Alternatively, you can visit a local DMV office to request a hard copy. It is advisable to check your state’s specific requirements, as processes may differ.
The DL-43 form generally requires personal information such as:
Additional information may be required based on your state’s regulations. Always review the form carefully to ensure all necessary details are included.
Yes, there is typically a fee associated with the processing of the DL-43 form. This fee can vary widely depending on your state and the type of application you are submitting. It is best to check the specific fee structure on your state’s DMV website or inquire directly at a DMV office.
Processing times for the DL-43 form can vary based on several factors, including the volume of applications being handled by the DMV and the completeness of your submission. Generally, you can expect processing to take anywhere from a few days to several weeks. If you have not received any confirmation after a reasonable period, it is wise to follow up with the DMV.
In many states, you can submit the DL-43 form online, especially if you are renewing your license. However, first-time applicants or those making significant changes may need to visit a DMV office in person. Always check your state’s DMV website for the most current submission options available.
If you notice an error after submitting the DL-43 form, contact your local DMV office as soon as possible. Depending on the nature of the mistake, they may be able to correct it without requiring you to resubmit the entire form. It is important to address any inaccuracies promptly to avoid delays in processing your application.
If you have questions or need assistance with the DL-43 form, your best resource is your state’s DMV website. They often provide detailed instructions and FAQs. You can also call or visit your local DMV office for personalized assistance. Staff members are trained to help you navigate the process and ensure your application is completed correctly.
The DL-43 form is a crucial document for many individuals, but several misconceptions surround it. Understanding these myths can help clarify its purpose and use. Here are six common misconceptions about the DL-43 form:
By addressing these misconceptions, individuals can approach the DL-43 form with a clearer understanding of its requirements and processes.