Form B-350 "Request for a Connecticut Driver's License/Identification Card by Mail" - Connecticut

What Is Form B-350?

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

Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the Connecticut Department of Motor Vehicles;
  • 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 B-350 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Motor Vehicles.

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Download Form B-350 "Request for a Connecticut Driver's License/Identification Card by Mail" - Connecticut

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REQUEST FOR A CONNECTICUT DRIVER'S
DMV VALIDATION AREA
LICENSE/IDENTIFICATION CARD BY MAIL
B-350 Rev. 12-17
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
CENTRAL ISSUANCE OPERATIONS UNIT
60 STATE STREET, WETHERSFIELD, CT 06109
(SEE INSTRUCTIONS ON BACK)
DATE OF BIRTH
NAME OF APPLICANT ON DRIVER'S LICENSE (Last, First, Middle Initial)
DRIVER'S LICENSE OR ID CARD NUMBER (If known)
EYE COLOR
GENDER
HEIGHT
STREET ADDRESS WHERE LICENSE IS TO BE MAILED
STATE
COUNTRY
ZIP/POSTAL CODE
CLASS (If known)
ENDORSEMENTS (If known)
RESTRICTIONS (If known)
CITY
SECTION A
STATE THE REASON YOU CANNOT APPEAR AT DMV IN PERSON
OUT-OF-STATE
OUT-OF-COUNTRY
INCARCERATED/INMATE NUMBER:
MILITARY
(Complete Section E on back of form)
OTHER (Explain):
APPLICATION FOR:
REASON FOR DUPLICATE:
DUPLICATE LICENSE ($30.00)
RENEWAL OF NON-DRIVER ID ($22.50)
LOST
RENEWAL OF DRIVER LICENSE
DUPLICATE NON-DRIVER IDENTIFICATION CARD ($30.00)
($72.00 for 6 year renewal or $24.00 for 2
STOLEN
year renewal. A 2 year renewal is only available for operators 65 years or older.)
DUPLICATE LEARNER PERMIT ($19.00)
DESTROYED
DRIVER LICENSE RENEWALS ONLY: IF YOU ARE RENEWING YOUR DRIVERS LICENSE THIS FORM MUST BE RECEIVED BY
THE DMV PRIOR TO YOUR EXPIRATION DATE.
AN ADDITIONAL LATE FEE OF $25 WILL APPLY IF YOUR RENEWAL AND PAYMENT IS RECEIVED BY DMV AFTER YOUR EXPIRATION DATE.
CONNECTICUT RESIDENT ADDRESS (Number, Street, City or Town, State, Zip Code) MILITARY: Connecticut address at time of induction
CONNECTICUT MAILING ADDRESS (If different from Connecticut resident address)
E-MAIL ADDRESS
MAY WE CONTACT YOU VIA E-MAIL?
PHONE NUMBER YOU CAN BE REACHED AT
FAX NUMBER (If available)
(If available)
YES
NO
THIS FORM CANNOT BE USED TO CHANGE YOUR ADDRESS PERMANENTLY -
DO YOU WANT TO BE IN THE ORGAN/TISSUE DONOR REGISTRY?
YOU MUST COMPLETE A INDIVIDUAL CHANGE OF ADDRESS (B-58) TO CHANGE
IF YES, YOU ARE AGREEING TO BE A DONOR AND
YES
NO
YOUR ADDRESS.
THE DESIGNATION WILL BE ON YOUR LICENSE.
SECTION B - CERTIFICATION FOR DRIVER'S LICENSES AND IDENTIFICATION CARDS
The information provided to the Commissioner of Motor Vehicles on this form is subscribed by me, the undersigned, under penalty of false statement, in accordance with the provisions of Sections 14-110 and
53a-157b of the Connecticut General Statutes. I understand that if I make a statement that I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution under the
above referenced laws. Additional Certification for Driver's License: I also swear or affirm, under penalty of false statement, that my driver's license or driving privilege is not suspended, revoked or
withdrawn, and that I do not have any health problems or conditions that prevent me from driving safely.
APPLICANT'S SIGNATURE
DATE
X
SECTION C - FEES
SECTION D - VOTER REGISTRATION APPLICATION
Circle applicable fees and determine correct amount
TO APPLY TO REGISTER TO VOTE YOU MUST BE: A United States citizen; at
least 18 years of age (by election day); and a resident of Connecticut and the city
FEE
TRANSACTION TYPE
or town where you are applying to register to vote.
Duplicate License (military personnel are not exempt from duplicate
Are you a citizen of the United States of America?
YES
NO
$30.00
fees)
Will you be 18 years of age on or before election day?
YES
NO
Duplicate Non-Driver Identification Card (military personnel are not
$30.00
If you checked "NO" in response to either of these questions, do
exempt from duplicate fees)
NOT complete below this line as you cannot register to vote.
Duplicate Learner Permit
$19.00
Do you wish to enroll in a political party?
$22.50
Renewal of Non-Driver ID
YES
NAME OF PARTY:
DEMOCRATIC
REPUBLICAN
Renewal of 6 year driver license
$72.00
OTHER:
Renewal of a 2 year driver license (only available for operators 65
$24.00
years or older)
NO
I DO NOT WISH TO ENROLL IN A PARTY AT THIS TIME AND
WILL BE REGISTERED AS UNAFFILIATED
LATE FEE for the renewal of driver license (A late fee will be
Note: Declaring a party enables you to vote in the party's primary election, which is
applied on all applications (must include payment) RECEIVED by
$25.00
open only to party members. You may later choose to switch enrollment to or from
DMV after its expirations date).
a political party.
LEAVING THIS SECTION BLANK WILL AUTOMATICALLY RESULT IN
TOTAL ENCLOSED
$
SELECTING UNAFFILIATED
VOTER DECLARATION:
PAYMENT ENCLOSED (Check or money order)
I swear or affirm under penalty of perjury that:
* I am a U.S. Citizen
* I live in Connecticut at the address shown above
CREDIT CARD PAYMENT (Please call (860)263-5401 1 business day after
* I am at least 17 years old and will be 18 years old on or before election day
emailing/faxing the form to provide credit card number. Credit card payments must
* I have not been convicted of a disfranchising felony, or if so,
be received prior to expiration date or the late fee will apply).
I am eligible to register to vote
SIGNATURE OF APPLICANT**
TODAY'S DATE
**Voter registrations without signatures will not be processed.
The information that I have provided is true to the best of my knowledge under
penalty of perjury. If I have provided false information, I may be subject to a fine or
imprisonment or both under federal or state laws.
By signing this application form, I agree to allow the signature from my license
record to be used as the signature on my voter registration record.
REQUEST FOR A CONNECTICUT DRIVER'S
DMV VALIDATION AREA
LICENSE/IDENTIFICATION CARD BY MAIL
B-350 Rev. 12-17
STATE OF CONNECTICUT
DEPARTMENT OF MOTOR VEHICLES
CENTRAL ISSUANCE OPERATIONS UNIT
60 STATE STREET, WETHERSFIELD, CT 06109
(SEE INSTRUCTIONS ON BACK)
DATE OF BIRTH
NAME OF APPLICANT ON DRIVER'S LICENSE (Last, First, Middle Initial)
DRIVER'S LICENSE OR ID CARD NUMBER (If known)
EYE COLOR
GENDER
HEIGHT
STREET ADDRESS WHERE LICENSE IS TO BE MAILED
STATE
COUNTRY
ZIP/POSTAL CODE
CLASS (If known)
ENDORSEMENTS (If known)
RESTRICTIONS (If known)
CITY
SECTION A
STATE THE REASON YOU CANNOT APPEAR AT DMV IN PERSON
OUT-OF-STATE
OUT-OF-COUNTRY
INCARCERATED/INMATE NUMBER:
MILITARY
(Complete Section E on back of form)
OTHER (Explain):
APPLICATION FOR:
REASON FOR DUPLICATE:
DUPLICATE LICENSE ($30.00)
RENEWAL OF NON-DRIVER ID ($22.50)
LOST
RENEWAL OF DRIVER LICENSE
DUPLICATE NON-DRIVER IDENTIFICATION CARD ($30.00)
($72.00 for 6 year renewal or $24.00 for 2
STOLEN
year renewal. A 2 year renewal is only available for operators 65 years or older.)
DUPLICATE LEARNER PERMIT ($19.00)
DESTROYED
DRIVER LICENSE RENEWALS ONLY: IF YOU ARE RENEWING YOUR DRIVERS LICENSE THIS FORM MUST BE RECEIVED BY
THE DMV PRIOR TO YOUR EXPIRATION DATE.
AN ADDITIONAL LATE FEE OF $25 WILL APPLY IF YOUR RENEWAL AND PAYMENT IS RECEIVED BY DMV AFTER YOUR EXPIRATION DATE.
CONNECTICUT RESIDENT ADDRESS (Number, Street, City or Town, State, Zip Code) MILITARY: Connecticut address at time of induction
CONNECTICUT MAILING ADDRESS (If different from Connecticut resident address)
E-MAIL ADDRESS
MAY WE CONTACT YOU VIA E-MAIL?
PHONE NUMBER YOU CAN BE REACHED AT
FAX NUMBER (If available)
(If available)
YES
NO
THIS FORM CANNOT BE USED TO CHANGE YOUR ADDRESS PERMANENTLY -
DO YOU WANT TO BE IN THE ORGAN/TISSUE DONOR REGISTRY?
YOU MUST COMPLETE A INDIVIDUAL CHANGE OF ADDRESS (B-58) TO CHANGE
IF YES, YOU ARE AGREEING TO BE A DONOR AND
YES
NO
YOUR ADDRESS.
THE DESIGNATION WILL BE ON YOUR LICENSE.
SECTION B - CERTIFICATION FOR DRIVER'S LICENSES AND IDENTIFICATION CARDS
The information provided to the Commissioner of Motor Vehicles on this form is subscribed by me, the undersigned, under penalty of false statement, in accordance with the provisions of Sections 14-110 and
53a-157b of the Connecticut General Statutes. I understand that if I make a statement that I do not believe to be true, with the intent to mislead the Commissioner, I will be subject to prosecution under the
above referenced laws. Additional Certification for Driver's License: I also swear or affirm, under penalty of false statement, that my driver's license or driving privilege is not suspended, revoked or
withdrawn, and that I do not have any health problems or conditions that prevent me from driving safely.
APPLICANT'S SIGNATURE
DATE
X
SECTION C - FEES
SECTION D - VOTER REGISTRATION APPLICATION
Circle applicable fees and determine correct amount
TO APPLY TO REGISTER TO VOTE YOU MUST BE: A United States citizen; at
least 18 years of age (by election day); and a resident of Connecticut and the city
FEE
TRANSACTION TYPE
or town where you are applying to register to vote.
Duplicate License (military personnel are not exempt from duplicate
Are you a citizen of the United States of America?
YES
NO
$30.00
fees)
Will you be 18 years of age on or before election day?
YES
NO
Duplicate Non-Driver Identification Card (military personnel are not
$30.00
If you checked "NO" in response to either of these questions, do
exempt from duplicate fees)
NOT complete below this line as you cannot register to vote.
Duplicate Learner Permit
$19.00
Do you wish to enroll in a political party?
$22.50
Renewal of Non-Driver ID
YES
NAME OF PARTY:
DEMOCRATIC
REPUBLICAN
Renewal of 6 year driver license
$72.00
OTHER:
Renewal of a 2 year driver license (only available for operators 65
$24.00
years or older)
NO
I DO NOT WISH TO ENROLL IN A PARTY AT THIS TIME AND
WILL BE REGISTERED AS UNAFFILIATED
LATE FEE for the renewal of driver license (A late fee will be
Note: Declaring a party enables you to vote in the party's primary election, which is
applied on all applications (must include payment) RECEIVED by
$25.00
open only to party members. You may later choose to switch enrollment to or from
DMV after its expirations date).
a political party.
LEAVING THIS SECTION BLANK WILL AUTOMATICALLY RESULT IN
TOTAL ENCLOSED
$
SELECTING UNAFFILIATED
VOTER DECLARATION:
PAYMENT ENCLOSED (Check or money order)
I swear or affirm under penalty of perjury that:
* I am a U.S. Citizen
* I live in Connecticut at the address shown above
CREDIT CARD PAYMENT (Please call (860)263-5401 1 business day after
* I am at least 17 years old and will be 18 years old on or before election day
emailing/faxing the form to provide credit card number. Credit card payments must
* I have not been convicted of a disfranchising felony, or if so,
be received prior to expiration date or the late fee will apply).
I am eligible to register to vote
SIGNATURE OF APPLICANT**
TODAY'S DATE
**Voter registrations without signatures will not be processed.
The information that I have provided is true to the best of my knowledge under
penalty of perjury. If I have provided false information, I may be subject to a fine or
imprisonment or both under federal or state laws.
By signing this application form, I agree to allow the signature from my license
record to be used as the signature on my voter registration record.
INSTRUCTIONS:
NOTE:
Out of State/Country Applicants: You MUST provide an out of state/country address, if you do not provide an out of
state/country address your application cannot be processed by mail and you must appear at your local branch office.
Your Connecticut license/identification will be sent to the out of state/country address provided via regular mail.
1.
Only legal residents of Connecticut with a VALID CT license/identification card who meet the following criteria may
use this application: a) must be temporarily located out of state/out of country b) currently incarcerated c) currently
suffering from an incapacitating medical condition, which does not allow you to appear in person for your
duplicate/renewal. (See number 5 for additional requirements)
2.
Complete section A entirely. Type or print clearly. Sign the certification in section B.
Complete Section D if you want to apply to register to vote in CT. To register, you must be a U.S. citizen and at least
3.
18 years old before the next election. You are not a voter until your application is approved by the registrar of voters
in your CT town of residence. If you do not receive an acceptance or rejection within three weeks, contact the
registrar of voters.
Military: If recently honorably discharged or an active member of the armed services of the United States, Section E
4.
(below) must be completed if requesting a no fee renewal. A fee exemption is not given for duplicate licenses or
identification cards.
5.
Medical Condition: If request is due to a incapacitating medical condition this application must be submitted with the
Request to renew or obtain duplicate by mail due to medical conditions (CI-1) form.
Send completed application through either postal mail, e-mail or fax (email or fax will reduce wait time).
6.
MAIL
Send the completed application and payment (fees are listed in section C) of check or money order drawn on
United States bank (dollar currency) and mail to:
Department of Motor Vehicles
60 State Street
Wethersfield, CT 06109
Attn: Central Issuance Operations Unit
E-MAIL OR FAX
E-mail completed form(s) to DMV.CIU@ct.gov or fax to 860-263-5591. After one business day contact the Central Issuance Operations
Unit at 860 263-5401 (Monday-Friday 8:30 a.m. to 3:00 p.m.) to make a credit card payment (MASTERCARD, VISA OR DISCOVER
ONLY).
NOTE - LICENSE RENEWALS: Payments must be received prior to or the day of expiration or $25.00 late fee will be charged.
The following transactions cannot process through the mail: Renewal of commercial driver license (CDL), public service license, name
change, or drive-only permit/license.
Per REAL ID Act, you are allowed only two consecutive renewals through the mail before a new photo is required.
ACTIVE MILITARY PERSONNEL ONLY SECTION E
Connecticut General Statutes, Section 14-50(c). The Commissioner of Motor Vehicles shall waive the operator's license fee and examination fee in the case
of any person in the active service of the armed forces of the United States who was a legal resident of Connecticut at the time of his induction; and for one
licensing period to any person honorably separated from service who applies therefore within two years following the date of separation and was a legal
resident of Connecticut at the time of his induction.
Present Active Service in U.S. Armed Forces
DATE OF INDUCTION
DATE OF SEPARATION
I AM ENTITLED TO A WAIVER
Honorably Separated From Active Service
BECAUSE OF (Check One)
(If checked, fill in date of separation and submit copy of separation papers -DD214)
RANK
BRANCH OF SERVICE
NAME AND MAILING ADDRESS OF ARMED FORCES UNIT
SIGNATURE OF APPLICANT
I certify that I was a legal resident of the state of Connecticut at the time of my induction and that all
information provided in this application is correct.
X
SIGNATURE OF COMMISSIONED OFFICER IN CHARGE (If Active)
I certify under penalty of false statement in accordance with provision of Section 14-110 and 53a-157b
of the Connecticut General Statutes that the above named applicant is in the active service of the U.S.
Armed Forces. I understand that if I make a statement which I do not believe to be true, with the
X
intent to mislead the Commissioner, I will be subject to prosecution under the above referenced laws.
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