Form 478 Application for Alaska Driver License, Permit or Identification Card - Alaska

Form 478 or the "Application For Alaska Driver License, Permit Or Identification Card" is a form issued by the Alaska Department of Administration.

Download a PDF version of the Form 478 down below or find it on the Alaska Department of Administration Forms website.

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STATE OF ALASKA
DIVISION OF MOTOR VEHICLES
APPLICATION FOR ALASKA DRIVER LICENSE,
PERMIT OR IDENTIFICATION CARD
LICENSE / PERMIT
CLASSIFICATION
ENDORSEMENTS
478
 Driver License
 Non-Commercial (D)
 Hazardous
 Passenger (P)
 Instruction Permit
 Motorcycle
 Tank (N)
 School Bus (S)
 Identification Card
 A
 B
 C
 Doubles / Triples (T)
CDL
Tank (N) + HazMat (H)
FULL
First
Middle
Last
Suffix
LEGAL
NAME:
AK license / permit / ID number, if applicable.
Date of Birth
Sex
Height
Weight
Hair Color
Eye Color
ft
in
PLACE
City
State
Country (If other than USA)
Social Security Number
OF
BIRTH:
Mailing Address (This address will appear on the license, permit or ID.)
City
State
Zip Code
Residence Address (Physical location – no PO Box or Mail Receiving Station addresses.)
City
State
Zip Code
Email
Phone #
I declare myself an honorably discharged US Armed Forces veteran and authorize DMV to send my personal
 YES
 NO
 N/A
VETERAN
information to the Dept. of Military and Veterans Affairs to provide benefits to me.
 YES
 NO
 N/A
I have a US Armed Forces honorable discharge and wish to have a veteran designation placed / retained on my license.
 YES
 NO
Would you like to be an organ donor with a designator displayed on your license / ID card?
ORGAN DONOR
Would you like to donate $1 or more to the anatomical gift awareness fund? If so, how much?
$
 YES  NO
Are you a U.S. Citizen? You may not register to vote if you are not a U.S. citizen. If you are not a US citizen skip to next section.
 YES  NO
Would you like to register to vote or make changes to your voter registration?
(In order to be a registered voter of Alaska, you must provide an Alaska residence address.)
VOTER
 YES  NO
Have been convicted of a felony?
REGISTRATION
 YES  NO
Have you been unconditionally discharged from your felony?
 YES  NO
Would you like your residence address kept confidential? (Your residence address must be DIFFERENT than your mailing
address to be kept confidential.)
PREVIOUS
List any previous / maiden names by which you have been known:
NAMES
List any States in which you have ever held a permit, license or id card:
 YES
 NO
Have your driving privileges ever been suspended or revoked or application for license refused?
DRIVER
State:
Date:
Reason:
LICENSE
State:
Date:
Reason:
QUESTIONS
Within the past 5 years, have you had a medical condition or impairment, mental or physical disorder, seizure, or any other
 YES
 NO
(You do not need to
health problems that could affect your ability to safely operate a motor vehicle?
answer these
questions for an ID
If yes, please explain:
card)
 YES
 NO
Within the last five years, have you had three or more alcohol or drug related convictions?
If yes, you must provide physician verification that the problem is under control or proof of completion of a rehabilitative treatment program
COMMERCIAL
Are you domiciled (permanent residence) in the State of Alaska?
 YES
 NO
DRIVERS ONLY
I acknowledge that receiving an Alaska Permit, License or ID card may cancel or invalidate any Permit, License or ID card from another state per the laws of that state. I have
personally reviewed the information on this application and certify under penalty of perjury that to the best of my knowledge and belief the information on this application is
true and correct. NOTE: Making a false statement in connection with this application may be punishable by a maximum penalty of $50,000 or five years imprisonment or both
per AS 11.46.505
.
X
Date
LOGIN ID / Office Number
Signature of Applicant (MUST SIGN IN FRONT OF A DMV REPRESENTATIVE)
*****DMV USE ONLY *****
LICENSE
Orig
Renew
Duplicate
VISION
With CL
Left
Both
Right
Vision Notes
CDL Color Blind Test:
ISSUED
TEST
20/
20/
20/
Class:
Without CL
Pass / Fail / Medical Card
DOCUMENTS SEEN / OTHER NOTES
(Rev.06/08/2018)
Alaska.gov/dmv
STATE OF ALASKA
DIVISION OF MOTOR VEHICLES
APPLICATION FOR ALASKA DRIVER LICENSE,
PERMIT OR IDENTIFICATION CARD
LICENSE / PERMIT
CLASSIFICATION
ENDORSEMENTS
478
 Driver License
 Non-Commercial (D)
 Hazardous
 Passenger (P)
 Instruction Permit
 Motorcycle
 Tank (N)
 School Bus (S)
 Identification Card
 A
 B
 C
 Doubles / Triples (T)
CDL
Tank (N) + HazMat (H)
FULL
First
Middle
Last
Suffix
LEGAL
NAME:
AK license / permit / ID number, if applicable.
Date of Birth
Sex
Height
Weight
Hair Color
Eye Color
ft
in
PLACE
City
State
Country (If other than USA)
Social Security Number
OF
BIRTH:
Mailing Address (This address will appear on the license, permit or ID.)
City
State
Zip Code
Residence Address (Physical location – no PO Box or Mail Receiving Station addresses.)
City
State
Zip Code
Email
Phone #
I declare myself an honorably discharged US Armed Forces veteran and authorize DMV to send my personal
 YES
 NO
 N/A
VETERAN
information to the Dept. of Military and Veterans Affairs to provide benefits to me.
 YES
 NO
 N/A
I have a US Armed Forces honorable discharge and wish to have a veteran designation placed / retained on my license.
 YES
 NO
Would you like to be an organ donor with a designator displayed on your license / ID card?
ORGAN DONOR
Would you like to donate $1 or more to the anatomical gift awareness fund? If so, how much?
$
 YES  NO
Are you a U.S. Citizen? You may not register to vote if you are not a U.S. citizen. If you are not a US citizen skip to next section.
 YES  NO
Would you like to register to vote or make changes to your voter registration?
(In order to be a registered voter of Alaska, you must provide an Alaska residence address.)
VOTER
 YES  NO
Have been convicted of a felony?
REGISTRATION
 YES  NO
Have you been unconditionally discharged from your felony?
 YES  NO
Would you like your residence address kept confidential? (Your residence address must be DIFFERENT than your mailing
address to be kept confidential.)
PREVIOUS
List any previous / maiden names by which you have been known:
NAMES
List any States in which you have ever held a permit, license or id card:
 YES
 NO
Have your driving privileges ever been suspended or revoked or application for license refused?
DRIVER
State:
Date:
Reason:
LICENSE
State:
Date:
Reason:
QUESTIONS
Within the past 5 years, have you had a medical condition or impairment, mental or physical disorder, seizure, or any other
 YES
 NO
(You do not need to
health problems that could affect your ability to safely operate a motor vehicle?
answer these
questions for an ID
If yes, please explain:
card)
 YES
 NO
Within the last five years, have you had three or more alcohol or drug related convictions?
If yes, you must provide physician verification that the problem is under control or proof of completion of a rehabilitative treatment program
COMMERCIAL
Are you domiciled (permanent residence) in the State of Alaska?
 YES
 NO
DRIVERS ONLY
I acknowledge that receiving an Alaska Permit, License or ID card may cancel or invalidate any Permit, License or ID card from another state per the laws of that state. I have
personally reviewed the information on this application and certify under penalty of perjury that to the best of my knowledge and belief the information on this application is
true and correct. NOTE: Making a false statement in connection with this application may be punishable by a maximum penalty of $50,000 or five years imprisonment or both
per AS 11.46.505
.
X
Date
LOGIN ID / Office Number
Signature of Applicant (MUST SIGN IN FRONT OF A DMV REPRESENTATIVE)
*****DMV USE ONLY *****
LICENSE
Orig
Renew
Duplicate
VISION
With CL
Left
Both
Right
Vision Notes
CDL Color Blind Test:
ISSUED
TEST
20/
20/
20/
Class:
Without CL
Pass / Fail / Medical Card
DOCUMENTS SEEN / OTHER NOTES
(Rev.06/08/2018)
Alaska.gov/dmv

Download Form 478 Application for Alaska Driver License, Permit or Identification Card - Alaska

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