Fillable Form Pennsylvania Driver License Replacement Form

What is the Pennsylvania Driver’s License Replacement Form?

Form DL-80, Non-Commercial Driver’s License Application for Change/Correction/Replacement or also referred to as the Pennsylvania Driver’s License Replacement Form is filed by the residents of the state of Pennsylvania to apply for a driver’s license replacement, to change or correct information on an existing driver’s license, and when an existing application but did not arrive in the mail within 90 days upon the application.

Why file the Pennsylvania Driver’s License Replacement Form?

Filing the Pennsylvania Driver’s License Replacement Form is recommended if no mail arrives within 90 days after your original application. Moreover, if your driver’s license, permit, or identification card was lost or stolen, you are qualified to apply for a replacement if:

• you do not have outstanding criminal charges or driving violations in Pennsylvania or other states; and
• your license is not revoked, suspended, or canceled.

How to Fill out the Pennsylvania Driver’s License Replacement Form?

Mark the appropriate box to determine your application. You may select:

• Replacement (Duplicate) — Answer only sections A, B, (C and D if applicable) E, and F. All requests with an asterisk need to be notarized.

• Change or Correction — Answer sections A, C, and F only, and notarization is not required.

Section A - You must complete all parts of Section A.

Driver’s License Number

Enter your existing driver’s license number.

Name

Enter your Last Name, First Name, Middle Name, and suffix, if applicable.

Date of Birth

Enter your date of birth in the following format: MM/DD/YYYY.

Telephone Number

Enter your telephone number that is available from 8:00 A.M. to 4:00 P.M.

Email Address

Enter your active email address.

Section B - Application type.

For a replacement, mark the appropriate box for your application. You may select:

• Regular camera card
• Photo license

• Update card
• “Photo-exempt” camera card
• Valid w.o photo license

Mark the appropriate box to determine the reason for the replacement. You may select:

• Lost
• Mutilated
• Stolen
• Correction
• Never received
• Other — Specify the type of replacement.

Mark “Add” if you agree to add organ donor designation; otherwise, mark “Remove.”

Section C - Change or Correction Only.

This section requires information you wish to replace your original records with.

Address Change

Enter your new Pennsylvania street address, city, state, and zip code. You may add your Post Office Box number but it cannot be used as your only address.

Mark “Yes” if you would like to notify your county voter registration office of this change; otherwise, mark “No.” If you are not a registered voter, you may directly contact your county voter registration office.

Name Change

Mark the appropriate box to determine the reason for your change of name. You may select:

• Married
• Divorced
• Other

Enter your new last name, name extension, if applicable, first name, and middle name. The name changes must be done by the person with the original documents.

Other Changes

Eye Color

Mark the appropriate box to determine your natural eye color. You may select:

• Blue
• Brown
• Green
• Hazel
• Pink
• Black
• Gray
• Dichromatic
• Other — Specify your eye color.

Correction of Date of Birth

Enter your correct date of birth, in the following format: MM/DD/YYYY.

Height

Enter your height in feet and inches.

Social Security Number (SSN)

Enter your social security number.

Drop Privilege

Check the box if you are dropping Class M.

Section D - Consent of Parent, Guardian, Person in Loco Parentis or Spouse at least 18 Years of Age

Your parent or guardian must fill out this section if you are below 18 years of age.

For the parent or guardian:

Mark the appropriate box to determine your relationship with the minor. You may select:

• Parent
• Guardian
• Person in Loco Parentis
• Spouse at least 18 years of age

Sign Here

Affix your signature.

Section E. All must be answered if replacement is requested.

1. Mark “Yes” if your driver’s license or driving privilege is suspended or revoked in this state or any other state; otherwise, mark “No.”
2. Mark “Yes” if you have any pending criminal charges or driving violations in this state or any other state; otherwise, mark “No.”

Section F. Authorization and Certification.

Mark the appropriate boxes to determine the situations you are authorizing. You may select:

• 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 wish to contribute $3.00 to the Organ Donation Awareness Trust Fund.
• I wish to contribute $3.00 to the Veterans’ Trust Fund.

Sign Here

Affix your signature and enter the date of signing.

Paid By

Mark the appropriate box to determine your type of payment. You may select:

• Debit/Credit Card
• Check
• Money Order

Guidelines in filling out the Pennsylvania Driver’s License Replacement Form

• If your lost or stolen license is about to expire within six (6) months, do not fill out this form and only complete the form DL-143, Renewal of Non-Commercial Driver’s License.

• Make sure that you also apply for a replacement immediately upon the loss of your driver’s license as it is illegal to drive a non-commercial vehicle without a driver’s license, and may result in several penalties and sanctions.

For replacement of non-commercial:

• The Pennsylvania Driver’s License Replacement Form collects fees upon application if you are applying for a replacement. You may refer to the instructions section of the form about the replacement fees details.

For change or correction only:

• If you are applying for a change or correction on your application only, there is no fee required. The bureau will provide an updated card reflecting the information you entered in this form.

• For name corrections, 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, present a state-issued birth certificate with a raised seal.

• For Social Security Number corrections, present your Social Security Card.

All name changes must be made in person at a Driver License Center and all documents must be original