Form 1-B Application for Duplicate of Current Permit, Driver's License, Id Card or Reprint of Temporary - Connecticut

Form 1-B is a Connecticut Department of Motor Vehicles form also known as the "Application For Duplicate Of Current Permit, Driver's License, Id Card Or Reprint Of Temporary". The latest edition of the form was released in June 1, 2017 and is available for digital filing.

Download a PDF version of the Form 1-B down below or find it on Connecticut Department of Motor Vehicles Forms website.

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APPLICATION FOR DUPLICATE OF CURRENT PERMIT,
DRIVER'S LICENSE, ID CARD OR REPRINT OF TEMPORARY
1-B REV. 6-2017
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
BRANCH OPERATIONS DIVISION
INSTRUCTIONS:
1.
Applicant must complete and sign this application. Type or print clearly.
2.
Applicant must present the required evidence of identity.
OFFICE USE ONLY
APPLICATION FOR: (Check One)
MOTORCYCLE LEARNER'S PERMIT
LEARNER'S PERMIT
COMMERCIAL LEARNER'S PERMIT (CLP)
DRIVER'S LICENSE
COMMERCIAL DRIVER'S LICENSE (CDL)
NON-DRIVER IDENTIFICATION CARD
REPRINT TEMPORARY
(
LP
LICENSE
ID)
HEIGHT OF OPERATOR
REASON FOR DUPLICATE/REPRINT (Check one)
LOST
STOLEN
DESTROYED
ft.
in.
OPERATOR'S NAME (Last, First, Middle)
DATE OF BIRTH
RESIDENT ADDRESS
(No. & Street)
(City or Town)
(State)
(Zip Code)
FORMER NAME AND/OR ADDRESS IF RECENTLY CHANGED
The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty of false statement, in
accordance with the provisions of Section 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if I make a statement which
I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution under the above-cited laws.
SIGNATURE OF OPERATOR
DATE SIGNED
X
APPLICATION FOR DUPLICATE OF CURRENT PERMIT,
DRIVER'S LICENSE, ID CARD OR REPRINT OF TEMPORARY
1-B REV. 6-2017
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
BRANCH OPERATIONS DIVISION
INSTRUCTIONS:
1.
Applicant must complete and sign this application. Type or print clearly.
2.
Applicant must present the required evidence of identity.
OFFICE USE ONLY
APPLICATION FOR: (Check One)
MOTORCYCLE LEARNER'S PERMIT
LEARNER'S PERMIT
COMMERCIAL LEARNER'S PERMIT (CLP)
DRIVER'S LICENSE
COMMERCIAL DRIVER'S LICENSE (CDL)
NON-DRIVER IDENTIFICATION CARD
REPRINT TEMPORARY
(
LP
LICENSE
ID)
HEIGHT OF OPERATOR
REASON FOR DUPLICATE/REPRINT (Check one)
LOST
STOLEN
DESTROYED
ft.
in.
OPERATOR'S NAME (Last, First, Middle)
DATE OF BIRTH
RESIDENT ADDRESS
(No. & Street)
(City or Town)
(State)
(Zip Code)
FORMER NAME AND/OR ADDRESS IF RECENTLY CHANGED
The information provided to the Commissioner of Motor Vehicles herein is subscribed by me, the undersigned, under penalty of false statement, in
accordance with the provisions of Section 14-110 and 53a-157b of the Connecticut General Statutes. I understand that if I make a statement which
I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution under the above-cited laws.
SIGNATURE OF OPERATOR
DATE SIGNED
X

Download Form 1-B Application for Duplicate of Current Permit, Driver's License, Id Card or Reprint of Temporary - Connecticut

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