Form DPSMV2013 "Temporarily Residing out of State Application for Reconstructed Duplicate/Renewal License/Id Card" - Louisiana

What Is Form DPSMV2013?

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

Form Details:

  • The latest edition provided by the Louisiana Department of Public Safety & Corrections;
  • 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 printable version of Form DPSMV2013 by clicking the link below or browse more documents and templates provided by the Louisiana Department of Public Safety & Corrections.

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Download Form DPSMV2013 "Temporarily Residing out of State Application for Reconstructed Duplicate/Renewal License/Id Card" - Louisiana

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TEMPORARILY RESIDING OUT OF STATE
APPLICATION FOR RECONSTRUCTED DUPLICATE/RENEWAL LICENSE/ID CARD
LOUISIANA DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONS
OFFICE OF MOTOR VEHICLES
SELECT ONE OF THE FOLLOWING:
RENEWAL REQUEST - EXPIRED LICENSE/ID CARD
DUPLICATE REQUEST – LOST OR STOLEN LICENSE/ID CARD
MUST BE COMPLETED
LICENCE/ID NUMBER (IF KNOWN)
DATE OF BIRTH (MM/DD/YY)
SOCIAL SECURITY NUMBER
RACE/SEX
EYES
HEIGHT
WEIGHT
DAYTIME PHONE NUMBER
PRINT FULL NAME
LAST
FIRST
MIDDLE/MAIDEN OR SUFFIX
TEMPORARY OUT OF STATE ADDRESS
APARTMENT NUMBER(IF APPLICABLE)
CITY/TOWN
STATE
ZIP
PERMANENT LOUISIANA RESIDENCE ADDRESS
CITY/TOWN
ZIP
MUST BE ANSWERED
1
. Are you a United States Citizen?
YES
NO
2. Have you ever experienced any loss of consciousness other than normal sleep?
YES
NO
If yes, please explain: ________________________________________________________________________________
3. Do you currently have any physical or mental condition which could impair your ability to operate a motor vehicle safely?
YES
NO
4. Do you wear contact lenses or glasses when driving?
YES
NO
MUST BE COMPLETE BY PARENT/GUARDIAN IF APPLICANT IS A MINOR CHILD
I certify that I am the
custodial parent
legal domiciliary parent
legal guardian of the minor applying and this is my authorization to the Office of Motor
Vehicles to issue a license/identification card as indicated above. I also declare by my signature below that information furnished by minor and me is complete and
correct. Signature of person authorized to sign in accordance with R.S. 32:407.
NOTE: Only the domiciliary parent can sign if joint custody has been awarded.
_________________________
License/ID Number
Signature _______________________________________________________
Printed Name ___________________________________________________
First
Middle/Maiden
Last
First
Middle/Maiden
Last
_____________________________________________
Notary Public Signature & Seal
COMPLETE FOR NAME CHANGE (PROPER DOCUMENTATION MUST BE ATTACHED)
NAME ON LICENSE/ID
NAME CHANGE TO
DECLARATION OF INTENT
By my signature affixed below, I certify under penalty of law, that: (1) all statements on this application are true and correct; (2) I have obtained Louisiana
registration on all vehicles I intend to operate in the State of Louisiana; (3) I have and will maintain vehicle liability insurance or security on all owned vehicles, as
required by R.S: 32:861-865; (4) I may be subject to certain criminal and/or civil penalties for offenses involving a commercial motor vehicle or a commercial
driver’s license if I am the operator of such motor vehicle or the holder of such license; (5) I meet the qualifications of 49 CFR 391 for interstate operation of a
commercial motor vehicle (if applicable); (6) I am in compliance with the CMV Safety Act of 1986; I do not and will not have in my possession more than one
driver’s license; (7) I hereby give my consent, under the provisions of R.S. 32:661 et Seq., to take a chemical test to determine the presence of alcohol or a
controlled dangerous substance in my blood while operating a motor vehicle, if required to do so by a law enforcement officer.
__________________
______________________________________________
DATE
SIGNATURE OF APPLICANT
OFFICE USE ONLY
OMV VERIFIER
OPERATOR NUMBER
OMV PROCESSOR
OPERATOR NUMBER
DPSMV2013
TEMPORARILY RESIDING OUT OF STATE
APPLICATION FOR RECONSTRUCTED DUPLICATE/RENEWAL LICENSE/ID CARD
LOUISIANA DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONS
OFFICE OF MOTOR VEHICLES
SELECT ONE OF THE FOLLOWING:
RENEWAL REQUEST - EXPIRED LICENSE/ID CARD
DUPLICATE REQUEST – LOST OR STOLEN LICENSE/ID CARD
MUST BE COMPLETED
LICENCE/ID NUMBER (IF KNOWN)
DATE OF BIRTH (MM/DD/YY)
SOCIAL SECURITY NUMBER
RACE/SEX
EYES
HEIGHT
WEIGHT
DAYTIME PHONE NUMBER
PRINT FULL NAME
LAST
FIRST
MIDDLE/MAIDEN OR SUFFIX
TEMPORARY OUT OF STATE ADDRESS
APARTMENT NUMBER(IF APPLICABLE)
CITY/TOWN
STATE
ZIP
PERMANENT LOUISIANA RESIDENCE ADDRESS
CITY/TOWN
ZIP
MUST BE ANSWERED
1
. Are you a United States Citizen?
YES
NO
2. Have you ever experienced any loss of consciousness other than normal sleep?
YES
NO
If yes, please explain: ________________________________________________________________________________
3. Do you currently have any physical or mental condition which could impair your ability to operate a motor vehicle safely?
YES
NO
4. Do you wear contact lenses or glasses when driving?
YES
NO
MUST BE COMPLETE BY PARENT/GUARDIAN IF APPLICANT IS A MINOR CHILD
I certify that I am the
custodial parent
legal domiciliary parent
legal guardian of the minor applying and this is my authorization to the Office of Motor
Vehicles to issue a license/identification card as indicated above. I also declare by my signature below that information furnished by minor and me is complete and
correct. Signature of person authorized to sign in accordance with R.S. 32:407.
NOTE: Only the domiciliary parent can sign if joint custody has been awarded.
_________________________
License/ID Number
Signature _______________________________________________________
Printed Name ___________________________________________________
First
Middle/Maiden
Last
First
Middle/Maiden
Last
_____________________________________________
Notary Public Signature & Seal
COMPLETE FOR NAME CHANGE (PROPER DOCUMENTATION MUST BE ATTACHED)
NAME ON LICENSE/ID
NAME CHANGE TO
DECLARATION OF INTENT
By my signature affixed below, I certify under penalty of law, that: (1) all statements on this application are true and correct; (2) I have obtained Louisiana
registration on all vehicles I intend to operate in the State of Louisiana; (3) I have and will maintain vehicle liability insurance or security on all owned vehicles, as
required by R.S: 32:861-865; (4) I may be subject to certain criminal and/or civil penalties for offenses involving a commercial motor vehicle or a commercial
driver’s license if I am the operator of such motor vehicle or the holder of such license; (5) I meet the qualifications of 49 CFR 391 for interstate operation of a
commercial motor vehicle (if applicable); (6) I am in compliance with the CMV Safety Act of 1986; I do not and will not have in my possession more than one
driver’s license; (7) I hereby give my consent, under the provisions of R.S. 32:661 et Seq., to take a chemical test to determine the presence of alcohol or a
controlled dangerous substance in my blood while operating a motor vehicle, if required to do so by a law enforcement officer.
__________________
______________________________________________
DATE
SIGNATURE OF APPLICANT
OFFICE USE ONLY
OMV VERIFIER
OPERATOR NUMBER
OMV PROCESSOR
OPERATOR NUMBER
DPSMV2013