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Pennsylvania

Pennsylvania

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Published by: drivershandbooks on Apr 16, 2011
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08/10/2014

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PennsylvaniaDriver’s Manual
(English Version)Department of TransportationDriver and Vehicle Services
 Pub. 95 (10-04)
80
0
 
Studying for your driver’s test?
Hey Teens!
www.dmv.state.pa.us
Click on the e-Government Logo, click onCitizen Services, Select Driver and VehicleServices, and then click on Young Drivers!
Visit:
See some of theactual driver’s testquestions!Merging intotraffic Ialmost...See possibledriving situations!My friends weredistracting meand...This is someserious stuff!See how the
web
can help you pass yourdriver’s test!Practicetaking someof the
real
examquestions!All right from
your
computer!
 
--
DL-180 (8-04)
MIDDLE NAMEFIRST NAMEJR., ETC
.DATE OF BIRTHSOCIAL SECURITY NUMBERSEXTELEPHONE (8:00 a.m. to 4:30 p.m.)
DRIVER'S LICENSE NUMBER/I.D. NUMBER:
INCHES
HEIGHT
FEETYEARDAYMONTH
( )
NON-COMMERCIALLEARNER'S PERMIT APPLICATION
PRINT ALL INFORMATION INBLACK OR BLUE INK
ALL QUESTIONS MUST BE ANSWERED
(Check [ 
 ] Applicable Blocks) 
YESNO
THIS FORM IS VALID FOR 1 YEAR FROM THE DATE OF PHYSICAL EXAMINATIONThe physical date may not be more than 6 months prior to your 16th birthday.
LAST NAME(S)
AUTHORIZATION AND CERTIFICATION
FOR PENNDOT USE ONLY
Exam Center:_______________________________________Date:________________MEDICAL RESTRICTIONS:____________________Signature of Examiner:_______________________________Badge No.:___________ 
VERIFICATION OF BIRTH DATE AND IDENTITY:
J
BIRTH CERTIFICATE
J
OTHER________________________________________________
J
QUALIFIED YES
J
UNABLE TO DETERMINE MEDICAL QUALIFICATIONS
ENTERFEEFOREACHITEMCHECKED
1.Have you ever held or possessed a PA Driver's License/Learner's Permit/Photo Identification Card?.........................................
J J
2.Is your right to apply for a license or your privilege to operate a vehicle in this or any other state currentlysuspended, revoked, or subject to installation of an ignition interlock device?..................................................................................
J J
If yes, give state__________date__________________,and reason______________________________________________ 3.Have you been arrested or cited in this state or any other state for any violation which carries a possiblepenalty of suspension or revocation of your driver's license or driving privilege?.............................................................................
J J
If yes, give state__________date__________________,and reason______________________________________________ 
STREET ADDRESS -
A Post Office Box number may be used in addition to the actual residence address, but cannot be used as the only address.
CITYZIP CODESTATE
PERMIT(S) DESIREDFEE
J
CLASS A (Combination Vehicle over 26,000)$5.00
J
CLASS B (Truck or Bus over 26,000)$5.00
J
CLASS C (Automobile)$5.00
J
CLASS M (Motorcycle) MSEA Fee is included$15.00
LICENSE REQUIREDFEE
J
4-Year Photo$26.00
J
2-Year Photo (Age 65 & Over)$15.50
J
Organ Donation Awareness Trust Fund (I wish to contribute $1.00)$1.00
PAID BY:
J
Check 
J
Money Order Payable To PENNDOT (Cash
CANNOT
be accepted)
I certify under penalty of law that this information contained herein is true and correct. I hereby authorize the Social Security Administration to releaseto the Department of Transportation information concerning my Social Security Identification Number for the purpose of identification. I herebyacknowledge this day that I have received notice of the provisions of Section 3709 of the Vehicle Code. (See back for provisions)
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 (18PA C.S. Section 4904[b]).
J
I am under the age of 18 years and I hereby request Organ Donor designation on my PA Driver’s License. Parent must checkconsent block on the Parent/Guardian Consent Form (DL-180TD).
(Applicants 18 years of age or older will have the opportunity to request Organ Donor designation at the Photo Center at the time they have their photo taken.) 
I hereby certify that I am a resident of the Commonwealth of Pennsylvania.
EYE COLOR (Please check one): 
PINKGRAYBROWNGREENHAZELBLACKDICHROMATICBLUEOTHER
(APPLICANT'S SIGNATURE IN INK)(DATE)
X
TOTAL $
SIGNHERE

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