Form DMV-116 "Property Owner Residency Affidavit" - Nevada

What Is Form DMV-116?

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

Form Details:

  • Released on July 1, 2013;
  • The latest edition provided by the Nevada 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 DMV-116 by clicking the link below or browse more documents and templates provided by the Nevada Department of Motor Vehicles.

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Download Form DMV-116 "Property Owner Residency Affidavit" - Nevada

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Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Rural Nevada (877) 368-7828
Fax: (775) 684-4992
Website:
www.dmvnv.com
Property Owner Residency Affidavit
This certification is used to support a claim that you are a Nevada resident. You must be a resident of Nevada to be
eligible for a driver’s license, driver authorization card (DAC) or identification card (NRS 483.250 (7), 483.290 (5)(b),
and 483.934). The definition of “resident” is found in NRS 483.141.
This certification will be accepted as one form of evidence for your principal residence address.
Customer Information
Name
Residence Address
City
State
Zip
NV
Mailing Address if different
City
State
Zip
NV
DL/DAC/ID Number
Social Security Number
(Not required for a DAC)
Property Owner Information
Name
Residence Address
City
State
Zip
NV
Mailing Address if different
City
State
Zip
NV
Choose ONE:
I certify that the above-named individual maintains a primary residence at my home without a rental or lease agreement.
I certify that the above-named individual has maintained a primary residence on the property I own as shown above for at
least 60 days and entered into a rental/lease agreement with me for this residence on ____________________________.
Date
Property Owner Signature
Date
DISCLOSURE STATEMENT: The Privacy Act of 1974 authorizes use of your Social Security Number to verify identity. You are required to
submit your Social Security Number so that the state may administer laws related to licensing drivers (NRS 483.290).
(Not required for a DAC)
I hereby certify under penalty of perjury that all statements in this application are true and correct. I agree and understand that any
misstatement of material facts may cause cancellation and/or denial of my driver license or identification card under NRS 483.420
and NRS 483.530, respectively. I further understand that any misstatement of facts may be a misdemeanor or felony under NRS
483.530, and may be punishable pursuant to NRS 193.130.
Applicant Signature
Date
(DMV-116, 7/13)
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Rural Nevada (877) 368-7828
Fax: (775) 684-4992
Website:
www.dmvnv.com
Property Owner Residency Affidavit
This certification is used to support a claim that you are a Nevada resident. You must be a resident of Nevada to be
eligible for a driver’s license, driver authorization card (DAC) or identification card (NRS 483.250 (7), 483.290 (5)(b),
and 483.934). The definition of “resident” is found in NRS 483.141.
This certification will be accepted as one form of evidence for your principal residence address.
Customer Information
Name
Residence Address
City
State
Zip
NV
Mailing Address if different
City
State
Zip
NV
DL/DAC/ID Number
Social Security Number
(Not required for a DAC)
Property Owner Information
Name
Residence Address
City
State
Zip
NV
Mailing Address if different
City
State
Zip
NV
Choose ONE:
I certify that the above-named individual maintains a primary residence at my home without a rental or lease agreement.
I certify that the above-named individual has maintained a primary residence on the property I own as shown above for at
least 60 days and entered into a rental/lease agreement with me for this residence on ____________________________.
Date
Property Owner Signature
Date
DISCLOSURE STATEMENT: The Privacy Act of 1974 authorizes use of your Social Security Number to verify identity. You are required to
submit your Social Security Number so that the state may administer laws related to licensing drivers (NRS 483.290).
(Not required for a DAC)
I hereby certify under penalty of perjury that all statements in this application are true and correct. I agree and understand that any
misstatement of material facts may cause cancellation and/or denial of my driver license or identification card under NRS 483.420
and NRS 483.530, respectively. I further understand that any misstatement of facts may be a misdemeanor or felony under NRS
483.530, and may be punishable pursuant to NRS 193.130.
Applicant Signature
Date
(DMV-116, 7/13)