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Fillable Form Nebraska Driver's License Application

A completed Nebraska Driver's License Application Form or Form DMV 06-104 is required to apply for a driver's license, driver's permit, or identification card in Nebraska.


What is the Nebraska Driver’s License Application form?

The Nebraska Driver’s License Application form or Form DMV-06-104is used by the residents of Nebraskato apply for a driver's license to drive legally in the state. Aside from its use as an application form, it may also be used to renew or replacea driver’s license, driver’s permit, and State Identification Card.

Who must have a Nebraska Driver's License?

All Nebraska residents who operate a motor vehicle on the streets and highways of the state are required by law to have a license. In addition, all new residents with a valid license from another state are required to obtain a Nebraska driver's license within 30 days.

How to fill out the Nebraska Driver’s License Application form?

The Nebraska Driver’s License Application form consists of two pages that you need to fill out completely. Follow the instructions below to answer the form accurately. Make sure that all the information you will provide is true to avoid any legal problems.

Date of Birth

Enter your date of birth in the following format: Month, Day, Year.

Social Security Number

Enter your unique nine-digit Social Security Number.

Legal Name

Enter your full legal name in the following format: Last Name, First Name, Middle Initial, Suffix.

Current Residential Address Required

Enter your current residential address, including the Street address or Route and P.O. Box, City, State, and ZIP code.

Current Mailing Address

If different from your residential address, enter your current mailing address, including City, State, and ZIP code.

Country Number

Enter your County Number.


Select your assigned gender at birth. Mark the “M” checkbox if male or the “F” checkbox if female.


Enter your height in Feet and Inches.


Enter your weight.

Eye Color

Enter the natural color of your eye.

Hair Color

Enter the natural color of your hair.


Select your race by marking the appropriate checkbox. You may mark the “Black,” “White,” “American Indian,” “Asian or Pacific Islander,” “Hispanic,” or “Other” checkbox.

For the purpose of complying with Neb. Rev. Stat. 60-484.04, I attest:

I am a citizen of the United States

If applicable, mark the “Yes” checkbox; otherwise, mark “No.”

I am not a citizen of the United States, but do have lawful status and agree to provide valid documentary evidence of such as outlined in 60-4,144

If applicable, mark the “Yes” checkbox; otherwise, mark “No.”

You may or may not answer the following motor voter and veteran questions:

Item 1A

Mark the “Yes” checkbox if you wish to register to vote as part of the application process; otherwise, mark “No.”

Item 1A1

Select your Party Affiliation. You may mark the “Republican,” “Democratic,” “Libertarian,” or “Non-Partisan (no party).”

Item 1B

Mark the “Yes” checkbox if you wish to have the word “Veteran” displayed on the front of your operator’s license or state identification card to show that you served in the armed forces of the United States; otherwise, mark “No.”

You may answer the following organ and tissue donation questions:

Item 2

Mark the “Yes” checkbox if you wish to include your name in the Donor Registry of Nebraska and donate your organs and tissues at the time of your death; otherwise, mark “No.”

Item 3

Mark the “Yes” checkbox if you wish to receive additional specific information regarding organ and tissue donation; otherwise, mark “No.”

Item 4

Mark the “Yes” checkbox if you wish to donate $1 to promote the Organ and Tissue Donor Awareness and Education Fund; otherwise, mark “No.”

If you are applying for a State ID Card, do not answer the following items:

Item 5

Mark the respective “Yes” checkboxes for the conditions that happened to you within the last three months; otherwise, mark the respective “No” checkboxes. Provide a date for items that require it.

a. lost voluntary control or consciousness

b. experienced vertigo or multiple episodes of dizziness or fainting

c. disorientation

d. seizures

e. impairment of memory, memory loss

Item 6

Mark the respective “Yes” checkboxes for the conditions that you experience which affect your ability to operate a motor vehicle due to loss or impairment; otherwise, mark the respective “No” checkboxes.

a. foot/leg

b. upper body strength

c. range of motion/mobility

d. hand/arm

e. neurological/neuromuscular disease

Item 7

Mark the “Yes” checkbox if since the issuance of your last license/permit your health or medical condition worsened; otherwise, mark “No.”

If you are applying for a school learner’s permit or a school permit, answer the following item:

Mark the “Yes” checkbox if your home or the school you attend is in a city of 5,000 or less; otherwise, mark “No.”

Sign and provide the date when you signed the form.

How to apply for a Nebraska Driver’s License?

To apply for a Nebraska driver's license, you may visitthe nearest Nebraska DMV licensingoffice to submit all the requirements. Aside from the Nebraska Driver's License Application form, you need to submit the following requirements:

  • One proof of U.S. Citizenship or Lawful Status. It must state your name, date of birth, and identity. E.g., a certified birth certificate, valid S. passport, I-94 or I-94A, valid Permanent Resident Card, etc.
  • Principal address in Nebraska (at least 2 documents). E.g., an account statement from a bank-issued within the last 90 days, valid NE vehicle registration, mortgage or rental agreement, blank check, etc.
  • Disclose your Social Security Numberor bring proof of exemption.

You must also pass a vision test. If necessary, to meet the minimum vision requirements, you may wear corrective lenses.

A written test will be given to you. Thewritten test has 25 questions about Nebraska driving laws and regulations. If you fail the test, you may retake it as early as the next business day. If you have alearner's permit (LPD) that is valid or expired no longer than a year ago, or you have completed a DMV-approved driversafety course, the test will be waived.

You must also pass the driving test and pay the fee of $26.50 for a 5-year license.

Keywords: DMV Form 06-104 Nebraska DL Application Form Apply for a Driver License in Nebraska NE Driver's License Application Form DMV DL Application Form NE Driver's License Application in Nebraska

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