Form 11-1400 "Application for Class D Driver License (Age 18 or Older) or Identification Card (All Applicants)" - Montana

What Is Form 11-1400?

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

Form Details:

  • Released on May 1, 2021;
  • The latest edition provided by the Montana Department of Justice;
  • 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 11-1400 by clicking the link below or browse more documents and templates provided by the Montana Department of Justice.

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Download Form 11-1400 "Application for Class D Driver License (Age 18 or Older) or Identification Card (All Applicants)" - Montana

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For Official Use Only:
Last Name
First Name
Middle Name
Suffix
New Issuance
REAL ID
Date:
Customer #
CJ#:
Renewal
MC
Amt Paid:
Docs:
Statement #
Replacement
ID
State of Montana
APPLICATION FOR CLASS D DRIVER LICENSE (age 18 or older)
-or-
IDENTIFICATION CARD (all applicants)
Print in BLACK or BLUE ink only | Customer Care Center: (406) 444-3933 mvd@mt.gov
Suffix(Jr., Sr., 1 st , etc.)
Legal Last Name
Legal First Name
Legal Middle Name
Date of Birth (mm/dd/yyyy) Sex
Eye Color
Weight
Height
United States Citizen?
Montana Resident?
Female
Yes
No
Yes
No
Male
Residential Address
City
State
Zip Code
Mailing Address
City
State
Zip Code
Place of Birth
Social Security Number
Email Address (if available)
Daytime Phone Number
LICENSING QUESTIONS:
1. Do you have any physical or mental condition that impairs or may impair your ability to exercise ordinary
and reasonable control in the safe operation of a motor vehicle on the highway? >>>>>>>>>>>>>
Yes
No
2. Do you rely on any adaptive equipment or operational restrictions to attain the ability to exercise ordinary
and reasonable control in the safe operation of a motor vehicle on the highway? >>>>>>>>>>>>>
Yes
No
3. Do you suffer from any chronic or potentially chronic condition that may cause a loss of consciousness or
control? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Yes
No
4. In the past 10 years, have you held a valid driver license or commercial driver license from any jurisdic-
tion (state) other than Montana? If yes, list all states:
Yes
No
5. Do you have a current or pending suspension, revocation, cancellation, disqualification, or withdrawal of
your driver license or privilege to drive by the State of Montana or by another state or jurisdiction? >>
Yes
No
If you are 18 or older, do you want your driver license or ID to show that you have a living will?
Yes
No
If you are 15 or older, do you want your driver license or ID to show that you are an organ donor? >>>>
Yes
Not Now
Do you have a prescription for corrective lenses? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Yes
No
VISION TEST: for office use only
Left Eye
Both Eyes
Right Eye
Color Perception
Present
Without glasses
20/
20/
20/
Absent
With glasses/contacts
20/
20/
20/
Depth
HEARING TEST: for office use only
Pass
Fail
Check if wearing hearing aid
Comments:
MCA 61-5-107 and USC 666(a)(13)
11-1400 (5/21)
<<< Please continue to the other side >>>
For Official Use Only:
Last Name
First Name
Middle Name
Suffix
New Issuance
REAL ID
Date:
Customer #
CJ#:
Renewal
MC
Amt Paid:
Docs:
Statement #
Replacement
ID
State of Montana
APPLICATION FOR CLASS D DRIVER LICENSE (age 18 or older)
-or-
IDENTIFICATION CARD (all applicants)
Print in BLACK or BLUE ink only | Customer Care Center: (406) 444-3933 mvd@mt.gov
Suffix(Jr., Sr., 1 st , etc.)
Legal Last Name
Legal First Name
Legal Middle Name
Date of Birth (mm/dd/yyyy) Sex
Eye Color
Weight
Height
United States Citizen?
Montana Resident?
Female
Yes
No
Yes
No
Male
Residential Address
City
State
Zip Code
Mailing Address
City
State
Zip Code
Place of Birth
Social Security Number
Email Address (if available)
Daytime Phone Number
LICENSING QUESTIONS:
1. Do you have any physical or mental condition that impairs or may impair your ability to exercise ordinary
and reasonable control in the safe operation of a motor vehicle on the highway? >>>>>>>>>>>>>
Yes
No
2. Do you rely on any adaptive equipment or operational restrictions to attain the ability to exercise ordinary
and reasonable control in the safe operation of a motor vehicle on the highway? >>>>>>>>>>>>>
Yes
No
3. Do you suffer from any chronic or potentially chronic condition that may cause a loss of consciousness or
control? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Yes
No
4. In the past 10 years, have you held a valid driver license or commercial driver license from any jurisdic-
tion (state) other than Montana? If yes, list all states:
Yes
No
5. Do you have a current or pending suspension, revocation, cancellation, disqualification, or withdrawal of
your driver license or privilege to drive by the State of Montana or by another state or jurisdiction? >>
Yes
No
If you are 18 or older, do you want your driver license or ID to show that you have a living will?
Yes
No
If you are 15 or older, do you want your driver license or ID to show that you are an organ donor? >>>>
Yes
Not Now
Do you have a prescription for corrective lenses? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Yes
No
VISION TEST: for office use only
Left Eye
Both Eyes
Right Eye
Color Perception
Present
Without glasses
20/
20/
20/
Absent
With glasses/contacts
20/
20/
20/
Depth
HEARING TEST: for office use only
Pass
Fail
Check if wearing hearing aid
Comments:
MCA 61-5-107 and USC 666(a)(13)
11-1400 (5/21)
<<< Please continue to the other side >>>
Federal law requires male citizens and certain aliens living in the U.S. to register for the
OTHER SERVICES OFFERED:
military selective service within 30 days of their eighteenth birthday. State law requires MVD to transmit registration informa-
tion to the military selective service if a person under 18 but at least 15 years old indicates on their driver license application
that they want to be registered on their eighteenth birthday.
Yes
No
Not Applicable
If you are at least 15, do you want to be registered with Selective Service when you turn age 18.
If you are veteran, do you want to add a VETERAN designation to your license? Verification of eligibility through the Montana
Department of Military Affairs is required. Visit
dma.mt.gov/MVAD/veterans-benefits.
Yes
Not Now
APPLICANT: I certify under penalty of law that the information I provided is true and correct to the best of my knowledge, infor-
mation, and belief. I understand that any false or misleading statement on my application may result in criminal prosecution,
cancellation of any license or card issued and/or my disqualification for a period of 60 days. I understand information may
be verified against nationwide systems. I understand that if Montana issues me a driver license or ID, any other card held in
another state will be canceled. I understand that if I am issued any other driver license or ID by any other state Montana will cancel
all driver licenses or IDs issued by Montana.
Signature:
Date:
VOTER REGISTRATION:
I want to register to vote or update my voter registration (continue on with application if selected)
I do not want to register to vote (end of application if selected)
I’m already registered to vote and do not want to update my information (end of application if selected)
County you reside in:
Yes
No
Are you a citizen of the United States? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Yes
No
Will you be at least 18 years of age on or before the next election?
>>>>>>>>>>>>>>
Yes
No
Will you be a Montana resident for at least 30 days before the next election?
>>>>>>>>
If you checked “No” in response to any of these questions, this is the end of the application.
Previous Registration Information - will be used to provide cancellation information to former jurisdiction.
Required if name changed or if previously registered to vote in another MT county or in another state.
Previous Registration Name
Residence Address of Previous Registration
Previous City
Previous County
Previous State
Previous Zip Code
Receive Your Ballot in the Mail
Yes, I request an absentee ballot to be mailed to me for all elections in which I am eligible to vote as long as I
reside at the address listed on this application. I understand that if I file a change of address with the U.S. Postal
Service, I must complete, sign, and return a confirmation notice mailed to me by the county election office.
Voter Application Affirmation
I affirm under penalty of perjury that the information on this application is true, that I am a citizen of the United
States, that I will be at least 18 years old on or before the next election, that I will have been a resident of Montana
for at least 30 days prior to the next election, and that I am not serving a felony conviction in a penal institution nor
have been found to be of unsound mind by a court. I understand that if I have given false information on this
application, I may be subject to a fine or imprisonment, or both, under federal and/or state law. By signing you
authorize the Motor Vehicle Division to use your electronic signature for voter registration purposes.
Signature
Date
The affirmation on this application for voter registration must be signed by the applicant. Failure to do so will prevent
the application from being processed.
Where you submit this form and your decision to not vote is confidential, and this information can only be used for
voter registration purposes.
You can visit the Montana Secretary of State “My Voter Page” to check if you are registered to vote, check your voter
registration address, and find the location and directions to your polling place at:
https://app.mt.gov/voterinfo/
11-1400 (5/21)
MCA 61-5-107 and USC 666(a)(13)
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