International Driver's License Application

For Email Transmission and Expedited Delivery

1.
Last name:
Patterson
2.
First Name:
Timothy
3.
Current Driver's License
1802 Parkway Street
Address:
Apt. # 178

San Diego, CA 90121

4.
Address to Mail IDL:
1802 Parkway Street

Apt. # 178

San Diego, CA 90121

5.
Email Address:

*****************
6.
Telephone:
215-649-0154
7.
*Passport #:

8.
*Passport Date of Issue#:
4/15/1999
9.
*Passport Place of Issue:
New Orleans, LA
10.
Place of Birth:
Baton Rouge, LA
11.
Date of Birth:
1/16/1979
12.
Nationality:
American
13.
Driver's License #:
a1234567
14.
State of Issue:
CA
15.
Date of Issue:
12/20/2005
16.

Expires On:
12/20/210

I understand that this international driver's license is in no way intended to replace a suspended
or revoked driver's license from the United States or any other country, and I am not applying for
this international driver's license to use as such. I do further understand that this international
driver's license will become null and void if a license is issued and the above is the actual
Intention of the applicant. I further release IDL International, Inc. from any and all said liability
caused by any misrepresentation on my part. I additionally release IDL International, Inc. from
any and all liability caused by applicant's failure to comply with any local, state, national, or
international law.

IDL INTERNATIONAL'S LIABILITY LIMITED TO THE REFUND OF LICENSE FEE.

Timothy Patterson
17.Applicant Signature: * Not Mandatory

Copyright 2008 IDL International, Inc., All Rights Reserved

Updated: February 13, 2008

Credit cards (VISA, MasterCard or American Express) are accepted for YOUR convenience. All credit card
transactions will be billed an additional $5.00 per license to offset processing fees.

Credit Card Authorization

Credit Card #:
341406194234099
Expiration Date:
02/2010
Name on Credit Card:
Timothy Patterson
Billing Address of
1802 Parkway Street
Credit Card:
Apt. # 178

San Diego, CA 90121

Authorized Card
Timothy Patterson
Holder Signature:

Copyright 2008 IDL International, Inc., All Rights Reserved

Updated: February 13, 2008