Form 427 "Certification for Change of Sex Designator on Driver License or Identification Card" - Alaska

What Is Form 427?

This is a legal form that was released by the Alaska Department of Administration - a government authority operating within Alaska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2020;
  • The latest edition provided by the Alaska Department of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 427 by clicking the link below or browse more documents and templates provided by the Alaska Department of Administration.

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Download Form 427 "Certification for Change of Sex Designator on Driver License or Identification Card" - Alaska

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STATE OF ALASKA
DIVISION OF MOTOR VEHICLES
CERTIFICATION FOR CHANGE OF SEX DESIGNATOR ON DRIVER LICENSE OR IDENTIFICATION CARD
This certification must be accompanied by one of the following:
Application for a Alaska Driver License, Permit or Identification Card (Form 478)
Commercial Driver Medical and Self Certifying Verification (Form 413) (if applicable)
If one of the following documents can be provided section B and C of this form are not required.
Amended Birth Certificate
Valid US Passport
Court Order issued by a court in the United States granting change of sex or gender
THIS FORM MUST BE COMPLETED IN FULL AND MUST BE COMPLETED IN BLACK OR BLUE INK.
A
APPLICANT INFORMATION AND SEX DESIGNATION STATEMENT
First
Middle
Last
Suffix
FULL
LEGAL
NAME:
ALASKA DL or ID number
Date of Birth
I wish the sex designation on my Driver License/ID Card to read:
Male
Female
_________________________________________
Signature
B
PATIENT MEDICAL RELEASE AUTHORIZATION
I
, authorize the licensed provider listed in section C to release
information related to this request. I hereby certify under penalty of unsworn falsification that this request for the selected sex designation to appear on my
driver’s license/ID Card accurately reflects my gender identity and is not for any fraudulent or other unlawful purpose.
X
Signature
Date
LICENSED PROVIDER CERTIFICATION
C
This section must be completed in full by a licensed physician in medicine or osteopathy, social worker, psychologist, professional
counselor, physician assistant or advanced nurse practitioner.
Patient Name
Provider Full Name
Provider Address
Telephone Number
Professional License Number
License-Issuing Jurisdiction
I am a licensed
physician in medicine or osteopathy
social worker
psychologist
professional counselor
physician assistant
advanced nurse practitioner
I hereby certify under penalty of unsworn falsification that I am a licensed provider in the field checked above. I have treated the applicant or reviewed and
evaluated the medical history of the applicant with regard to the condition necessitating the requested change of sex designator on the driver license or ID
card. The applicant has had appropriate clinical treatment for the condition necessitating the change and the change is expected to be permanent. The
applicant’s gender identification is
Male
Female.
X
X
Provider Signature
Provider Printed Name and Title
Date
THE PROVIDER SIGNATURE MUST BE ORIGINAL AND MAY NOT BE STAMPED OR IN AN ELECTRONIC FORMAT.
DMV
• Amended Birth Certificate
• Valid US Passport
• US Court Order
Use Only
Jurisdiction: ______________
Number : _________________
Jurisdiction: ______________
For questions or information on changing the sex designator on a license please contact:
Anchorage Driver Licensing
3901 Old Seward Hwy, Ste 101
Anchorage, Alaska 99503
(907) 269-5551 Phone
(907) 269-3774 Fax
Form 427 (Rev. 12/2020)
Alaska.gov/dmv
STATE OF ALASKA
DIVISION OF MOTOR VEHICLES
CERTIFICATION FOR CHANGE OF SEX DESIGNATOR ON DRIVER LICENSE OR IDENTIFICATION CARD
This certification must be accompanied by one of the following:
Application for a Alaska Driver License, Permit or Identification Card (Form 478)
Commercial Driver Medical and Self Certifying Verification (Form 413) (if applicable)
If one of the following documents can be provided section B and C of this form are not required.
Amended Birth Certificate
Valid US Passport
Court Order issued by a court in the United States granting change of sex or gender
THIS FORM MUST BE COMPLETED IN FULL AND MUST BE COMPLETED IN BLACK OR BLUE INK.
A
APPLICANT INFORMATION AND SEX DESIGNATION STATEMENT
First
Middle
Last
Suffix
FULL
LEGAL
NAME:
ALASKA DL or ID number
Date of Birth
I wish the sex designation on my Driver License/ID Card to read:
Male
Female
_________________________________________
Signature
B
PATIENT MEDICAL RELEASE AUTHORIZATION
I
, authorize the licensed provider listed in section C to release
information related to this request. I hereby certify under penalty of unsworn falsification that this request for the selected sex designation to appear on my
driver’s license/ID Card accurately reflects my gender identity and is not for any fraudulent or other unlawful purpose.
X
Signature
Date
LICENSED PROVIDER CERTIFICATION
C
This section must be completed in full by a licensed physician in medicine or osteopathy, social worker, psychologist, professional
counselor, physician assistant or advanced nurse practitioner.
Patient Name
Provider Full Name
Provider Address
Telephone Number
Professional License Number
License-Issuing Jurisdiction
I am a licensed
physician in medicine or osteopathy
social worker
psychologist
professional counselor
physician assistant
advanced nurse practitioner
I hereby certify under penalty of unsworn falsification that I am a licensed provider in the field checked above. I have treated the applicant or reviewed and
evaluated the medical history of the applicant with regard to the condition necessitating the requested change of sex designator on the driver license or ID
card. The applicant has had appropriate clinical treatment for the condition necessitating the change and the change is expected to be permanent. The
applicant’s gender identification is
Male
Female.
X
X
Provider Signature
Provider Printed Name and Title
Date
THE PROVIDER SIGNATURE MUST BE ORIGINAL AND MAY NOT BE STAMPED OR IN AN ELECTRONIC FORMAT.
DMV
• Amended Birth Certificate
• Valid US Passport
• US Court Order
Use Only
Jurisdiction: ______________
Number : _________________
Jurisdiction: ______________
For questions or information on changing the sex designator on a license please contact:
Anchorage Driver Licensing
3901 Old Seward Hwy, Ste 101
Anchorage, Alaska 99503
(907) 269-5551 Phone
(907) 269-3774 Fax
Form 427 (Rev. 12/2020)
Alaska.gov/dmv