Fillable Form West Virginia ID Application (DS 23-P)

What is the West Virginia State ID Application Form?

Form DS 23-P, Application for a Driver’s License or Identification Card, or also referred to as the West Virginia State ID Application Form, is used by the residents of the state of West Virginia to apply for an original, duplicate, or renewed learner’s permit, driver’s license, motorcycle license, or state identification card from the West Virginia Department of Motor Vehicles.

How to fill out the West Virginia State ID Application Form?

To fill out the West Virginia State ID Application Form, you must provide the following information:

Name

Enter your legal last name, first name, and middle name.

Former Names

Enter all of your former names. Supporting legal documentation must be submitted along with this form.

Residence Address

Enter your residence address.

Mailing Address

Enter your mailing address.

City, State, ZIP Code

Enter your city, state, and ZIP code along with your address.

Social Security Number

Enter your Social Security Number (SSN).

West Virginia License Number

Enter your West Virginia License Number.

Birth Date

Enter your date of birth using the format: Month-Day-Year.

Gender

Enter your gender.

Weight

Enter your weight in pounds.

Height

Enter your height in feet and inches.

Eye Color

Enter your natural eye color.

Daytime Phone

Enter your daytime phone number.

Cellular Phone

Enter your cellular phone number.

Email Address

Enter your email address.

Questions

Mark YES if your address has changed since your last license or identification card issuance; otherwise, mark NO.

Mark YES if you are a citizen of the United States; otherwise, mark NO and enter your Alien Registration Number (ARN).

Mark YES if you have been issued a license or identification card in another jurisdiction in the last 10 years; otherwise, mark NO. If you marked YES, enter the jurisdiction and your license or identification card number.

Mark YES if you have had a suspended or revoked license or a pending license suspension or revocation in any jurisdiction within the previous 5 years; otherwise, mark NO. If you marked YES, you are required to provide a letter of explanation that includes the date of the incident.

Mark YES if you have been refused a license by any jurisdiction within the previous 5 years; otherwise, mark NO. If you marked YES, you are required to provide a letter of explanation that includes the date of the incident.

Mark YES if you owe a child support obligation that is more than 6 months in arrears; otherwise, mark NO.

Mark YES if you are a Level 2 Graduated Driver Licensing Applicant that has been convicted of a traffic violation in the past 6 months; otherwise, mark NO.

Mark YES if you are a Level 3 Graduated Driver Licensing Applicant that has been convicted of a traffic violation in the past 12 months; otherwise, mark NO.

Mark YES if you have any visual or medical conditions affecting your ability to drive safely; otherwise, mark NO. If you marked YES, you are required to provide a letter of explanation.

Mark YES if you wish to be designated on your license as an organ donor; otherwise, mark NO. If you marked yes, you agree that the Department of Motor Vehicles may furnish your personal information to designated organ donation groups.

Mark YES if you wish to be designated on your license as a diabetic; otherwise, mark NO. If you marked YES, a licensed physician is required to certify your condition by completing the Medical Endorsement section of this form.

Mark YES if you want to have the United States Veterans designation on your license; otherwise, mark NO. If you marked YES, the Department of Motor Vehicles is required to verify your status using one of the following forms:

• DD Form 214 - Certificate of Release or Discharge From Active Duty
• WD AGO 53 - Enlisted Record and Report of Separation Honorable Discharge
• WD AGO 55 - Honorable Discharge from The Army of the United States
• WD AGO 53-55 - Enlisted Record and Report of Separation Honorable Discharge
• NAVPERS 553 - Notice of Separation from U.S. Naval Service
• NAVMC 78PD - U.S. Marine Corps Report of Separation
• NAVCG 553 - Notice of Separation from U.S. Coast Guard
• Military identification card or a current military license plate registration card

Mark YES if you have ever experienced seizures or loss of consciousness, emotional or mental illness, alcohol or drug problems, or any physical condition that requires you to use special equipment to drive; otherwise, mark NO. If you marked YES, you are required to provide a letter of explanation.

Mark YES if you are 18 and above and want to register to vote; otherwise, mark NO.

Mark YES if you wish to make a contribution to the West Virginia State Police Forensic Laboratory Fund; otherwise, mark NO. If you marked YES, enter the amount you wish to contribute.

Mark YES if you wish to make a contribution to the West Virginia Department of Veterans Assistance; otherwise, mark NO. If you marked YES, mark the box that corresponds to the amount you wish to contribute. You may select:

• $3
• $5
• $10

Type of License/ID Applicant Wishes to Obtain

Mark the appropriate box that corresponds to the type of license or identification card you wish to obtain. You may select:

• Instruction Permit: Level 1, Age 15-17
• Skills Test: Level 2, Age 16-17
• Level 3 License
• Instruction Permit “E”: Age 18 and Over
• Skills Test E: Age 18 and Over
• Instruction Permit “F”
• Motorcycle SKills: Test/Safety Course
• Motorcycle Endorsement
• Transfer
• Renewal
• Duplicate License
• “For Federal Identification” Federally Compliant Card
• Child ID Card: Ages 2 through 15
• ID Card: Ages 16 and Over
• Secondary ID Card

Physician/Audiologist Certification for Medical Endorsement

To certify that you have a medical condition, a licensed physician or audiologist must mark the appropriate box that corresponds to your condition. They may select:

• Diabetic
• Deaf
• Hard of hearing

Signature

The physician or audiologist must affix his or her signature.

Medical License Number

The physician or audiologist must enter his or her medical license number (MLN).

State

The physician or audiologist must enter his or her state.

Address

The physician or audiologist must enter his or her complete address.

Business Phone

The physician or audiologist must enter his or her business phone number.

Affidavit of West Virginia Residency: Homeowner Information and Certification

Name of Homeowner

The homeowner must enter his or her full legal name.

Name of Applicant

Enter your full legal name.

Address

Enter your complete address including the street, city, state, and ZIP code.

Signature of Homeowner

The homeowner must affix his or her signature.

Driver’s License or ID Number

Enter your West Virginia Driver’s License or Identification Card Number.

Date

Enter the current date using the format: Month-Day-Year.

Applicant Signature

Affix your signature.

Date

Enter the current date.

Parent/Guardian Signature

If you are an applicant who is under 18, have your parent or guardian affix his or her signature instead.