Fill a Valid DL-43 Template Open Editor Here

Fill a Valid DL-43 Template

The DL-43 form is a vital document used in the process of applying for a Pennsylvania driver's license or identification card. This form is designed to collect essential information from applicants, ensuring that all necessary details are accurately recorded. If you're ready to begin your application, click the button below to fill out the form.

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Form Overview

Fact Name Description
Form Purpose The DL-43 form is used for applying for a Pennsylvania driver's license or identification card.
Governing Law This form is governed by the Pennsylvania Vehicle Code, Title 75.
Eligibility Applicants must be at least 16 years old to apply for a learner's permit.
Required Documents Proof of identity, residency, and Social Security number are required when submitting the form.
Submission Method The completed DL-43 form can be submitted online, by mail, or in person at a DMV office.
Fees There is a fee associated with the application, which varies based on the type of license requested.
Processing Time Processing times for the DL-43 form can vary, typically taking a few weeks.
Renewal Process The DL-43 form is also used for renewing a driver's license or ID card in Pennsylvania.
Additional Requirements Vision tests may be required for applicants applying for a new license or renewing an existing one.
Contact Information For assistance, applicants can contact the Pennsylvania Department of Transportation.

Common Questions

  1. What is the DL-43 form?

    The DL-43 form is an application used for obtaining a Pennsylvania driver's license or identification card. It serves as a key document for individuals looking to apply for, renew, or replace their driver's license or ID in the state.

  2. Who needs to fill out the DL-43 form?

    Anyone who is applying for a new driver's license, renewing an existing license, or replacing a lost or stolen license in Pennsylvania must complete the DL-43 form. This includes first-time applicants as well as those who are updating their information.

  3. Where can I obtain the DL-43 form?

    The DL-43 form can be obtained online through the Pennsylvania Department of Transportation (PennDOT) website. It is also available at local PennDOT offices and various service centers throughout the state.

  4. What information do I need to provide on the DL-43 form?

    You will need to provide personal information such as your name, address, date of birth, and Social Security number. Additionally, if applicable, you must include details about your previous driver's license or ID, including its number and the state that issued it.

  5. How do I submit the DL-43 form?

    The completed DL-43 form can be submitted in person at a PennDOT office or service center. Some applicants may also have the option to submit it online, depending on their specific situation. Always check the latest guidelines from PennDOT for submission options.

  6. Is there a fee associated with the DL-43 form?

    Yes, there is typically a fee for processing the DL-43 form. The amount varies depending on whether you are applying for a new license, renewing, or replacing one. Check the PennDOT website for the most current fee schedule.

  7. How long does it take to process the DL-43 form?

    Processing times can vary. Generally, if you submit the form in person, you may receive your new license or ID on the same day. If you submit it online or by mail, it could take several weeks. It is advisable to plan ahead and check with PennDOT for specific timelines.

Documents used along the form

The DL-43 form is commonly associated with various processes, particularly in the realm of driver's licenses and identification. When applying for or renewing a driver's license, several other forms and documents may be required to ensure compliance with state regulations. Below are some of the key documents that are often used alongside the DL-43 form.

  • Proof of Identity: This document verifies the applicant's identity and may include a passport, birth certificate, or social security card. It is essential for establishing the individual's legal name and date of birth.
  • Proof of Residency: Applicants must provide evidence of their current address. Acceptable documents include utility bills, bank statements, or lease agreements that display the applicant's name and address.
  • Wisconsin Articles of Incorporation Form: This document is essential for establishing a corporation in Wisconsin and can be accessed through PDF Templates to streamline the process.
  • Medical Certification: For certain applicants, especially those with specific health conditions, a medical certification form may be required. This document confirms that the individual meets the necessary health standards to operate a vehicle safely.
  • Vision Test Results: A vision test is often mandatory to ensure that the applicant meets the minimum vision requirements for driving. Results from an eye exam conducted by a licensed optometrist or ophthalmologist may need to be submitted.

Understanding these accompanying documents can streamline the application process for a driver's license. Being prepared with the necessary paperwork will help ensure a smoother experience when submitting the DL-43 form.

Preview - DL-43 Form

 

APPLICATION FOR RENEWAL/REPLACEMENT/CHANGE

 

 

 

 

 

 

(Replacement also called Duplicate)

 

 

 

 

OF A TEXAS DRIVER LICENSE OR IDENTIFICATION CARD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DL or ID NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPLICANT INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTACT INFORMATION

 

 

 

 

 

 

 

LAST NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOME PHONE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRST NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER PHONE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MIDDLE NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMAIL:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUFFIX:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAIDEN NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RESIDENCE ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE OF BIRTH (mm/dd/yyyy):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE:

 

 

 

 

 

SSN:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ZIP CODE:

 

 

 

 

 

 

 

 

COUNTY:

 

 

 

 

 

 

 

 

 

SEX: (Mark One)

 

MALE

 

FEMALE

 

 

WEIGHT: lbs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EYE COLOR:

 

 

 

 

 

 

 

 

 

 

 

 

 

HEIGHT: ft.

 

 

 

 

 

 

in.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RACE/ETHNICITY:

 

 

 

 

 

 

 

(I)

American Indian/Alaska

Native

 

 

CITY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(A) Asian/Pacific Islander

(B) Black (H) Hispanic (O) Other

(W) White

ZIP CODE:

 

 

 

 

 

 

 

 

COUNTY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION FORM (ALL APPLICANTS please answer questions 1 through 10)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. YES NO

 

Are you a citizen of the United States?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

 

 

 

If you are a US citizen, would you like to register to vote? If registered, would you like to update your voter information?

 

 

 

 

 

 

 

 

 

By providing my electronic signature, I understand the personal information on my application form and my electronic signature will be used for submitting

 

 

 

 

 

 

my voter’s registration application to the Texas Secretary of State’s office. Wanting to register to vote, I authorize the Department of Public Safety to

3.

 

 

 

 

 

transfer this information to the Texas Secretary of State.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you wish to donate $1.00 to the Blindness Education Screening and Treatment Program?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

Do you want to support the Glenda Dawson Donate Life Texas donor registry? If yes, please indicate a donation amount of $1 or more $

 

.00

5.

 

 

 

 

 

Would you like to register as an organ donor?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

 

 

 

 

 

Do you want to support survivors of sexual assault? If yes, please indicate a donation amount of $1 or more $

 

 

 

.00 to help fund the testing

 

 

 

7.

 

 

 

 

 

of sexual assault evidence collection kits (rape kits).

 

 

 

 

 

 

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you want to support Texas Veterans?

If yes, please indicate your donation amount $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

 

 

 

 

 

Do you have a health condition that may impede communication with a peace officer? If yes, please list

 

 

 

 

 

 

 

9.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(physician must complete form DL-101 prior to the issuance of a DL/ID).

 

 

 

 

 

a) Do you want a Veteran designator on your driver license or identification card?

(proof of Honorable discharge required; acceptable documents

 

 

 

 

 

 

b)

are DD214/5, NGB22, VA disability letter, proof of service/verification of honorable service card)

 

 

 

 

 

 

 

10.

 

 

 

 

 

Are you a 60% disabled Veteran receiving compensation and want to waive the application fee? (see 9a for documents required)

 

 

 

 

 

 

 

 

In the event of injury or death would you like to provide two (2) emergency contacts? If yes, please list:

 

 

 

 

 

 

 

 

 

 

 

 

 

a)

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b)

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

For all Driver License Renewals complete MEDICAL questions 11 to 17. Answers to the questions below are for the confidential use of the Department.

 

 

 

11.

 

 

 

 

 

Do you currently have or have you ever been diagnosed with or treated for any medical condition that may affect your ability to safely operate a

 

 

 

 

 

 

 

 

 

motor vehicle?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Examples, including but not limited to: Diagnosis or treatment for heart trouble, stroke, hemorrhage or clots, high blood pressure, emphysema (within past two years)

 progressive eye disorder or injury (i.e., glaucoma, macular degeneration, etc.)  loss of normal use of hand, arm, foot or leg  blackouts, seizures, loss of consciousness

or body control (within the past two years) 

difficulty turning head from side to side

 loss of muscular control  stiff joints or neck  inadequate hand/eye

coordination  medical condition that affects your judgment  dizziness or balance problems

 missing limbs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you answered YES above, has your condition

IMPROVED or

DETERIORATED since your last application for an original/renewal remake of your driver license?

12.

 

 

 

 

 

Do you have a mental condition that may affect your ability to safely operate a motor vehicle?

If yes, please explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever had an epileptic seizure, convulsion, loss of consciousness, or other seizure?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

 

 

 

 

Do you have diabetes requiring treatment by insulin?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

 

 

 

 

Do you have any alcohol or drug dependencies that may affect your ability to safely operate a motor vehicle or have you had any episodes

 

 

 

16.

 

 

 

 

of alcohol or drug abuse within the past two years?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Within the past two years, have you been treated for any other serious medical conditions?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17.

 

 

 

 

Explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you EVER been referred to the Texas Medical Advisory Board for Driver Licensing?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Any male United States citizen or immigrant who is at least 18 years of age but less than 26 years of age submitting this application consents to registration with the

United States Selective Service System. You must be registered to qualify for federal student aid (to include Pell grant), job training, federal employment, and citizenship

if an immigrant. In Texas, you must be registered to qualify for state college student aid or state employment. If convicted, failure to register with the Selective Service is

a felony punishable by up to five years in prison and/or a $250,000 fine. If not registered by age 26, you can no longer register and could permanently lose those benefits

associated with registration. For alternative options for applicants who object to conventional military service for religious or other conscientious reasons information is

available at: http://www.sss.gov/FactSheets/FSaltsvc.pdf.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I do solemnly swear, affirm, or certify that I am the person named herein and that the statements on this information form are true and correct. I further certify my resi-

dence address is a (check one): (

) single family dwelling, (

 

) apartment, ( ) motel, (

) temporary shelter. I agree to immediately report to the Texas Department of

Public Safety any changes in my medical condition which may affect my ability to safely operate a motor vehicle.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DL-43 (Rev. 1/18)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OF APPLICANT

 

 

 

 

 

 

 

 

 

 

DATE

 

 

 

 

SOLICITUD PARA RENOVAR, REEMPLAZAR, Ó HACER

 

(El reemplazo también es llamado duplicado)

 

CAMBIOS EN LA LICENCIA DE CONDUCIR O TARJETA DE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NUMERO DE LICENCIA O DE TARJETA DE IDENTIFICACIÓN:

 

 

 

 

IDENTIFICACIÓN DEL ESTADO DE TEXAS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMACIÓN DEL SOLICITANTE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMACIÓN DE CONTACTO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APELLIDO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NÚMERO DE TELÉFONO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRIMER NOMBRE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TELÉFONO SECUNDARIO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SEGUNDO NOMBRE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CORREO ELECTRÓNICO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUFIJO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SU DOMICILIO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APELLIDO DE SOLTERA:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOMICILIO DONDE RESIDE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FECHA DE NACIMIENTO (mm/dd/aaaa):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CIUDAD:

 

 

 

 

 

 

 

 

 

 

 

 

 

ESTADO:

 

 

 

 

 

NÚMERO DE SEGURO SOCIAL:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CÓDIGO POSTAL:

 

 

 

 

CONDADO:

 

 

 

 

 

 

SEXO: (Marque uno)

HOMBRE

MUJER

PESO: en libres.

 

 

 

 

 

 

DOMICILIO POSTAL (Lugar donde recibe su correspondencia):

 

 

 

 

COLOR DE LOS OJOS:

 

 

 

 

 

 

 

 

ESTATURA: pies

 

 

 

 

pulg.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RAZA/ETNIA:

 

 

 

(I) Amerindio/Nativo de Alaska

(A) Asiático/nativo

 

 

 

CIUDAD:

 

 

 

 

 

 

 

 

 

 

 

ESTADO:

 

 

 

 

 

de las Islas del Pacífico (B) Negro (H) Hispano (O) Otro (W) Blanco

 

 

 

 

 

 

CÓDIGO POSTAL:

 

 

 

 

CONDADO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMACIÓN SOBRE EL SOLICITANTE (TODOS LOS SOLICITANTES favor de contestar las preguntas 1 a 10)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

SI NO

¿Es usted ciudadano de los Estados Unidos?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

 

Si usted es ciudadano de los Estados Unidos, ¿le gustaría registrarse para votar? Si ya está registrado, ¿le gustaría actualizar su información de votante?

 

 

 

 

Al proporcionar mi firma electrónica, comprendo que la información personal en mi solicitud, junto con mi firma electrónica, se usará para enviar mi

 

 

 

 

solicitud de registro electoral a la oficina de la Secretaría del Estado de Texas. Deseo registrarme para votar; por lo tanto, autorizo al Departamento

3.

 

 

 

de Seguridad Pública para transferir esta información a la Secretaría del Estado de Texas.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

¿Desea usted donar $1.00 al Programa de Educación, Evaluación y Tratamiento de la Ceguera?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

¿Desea apoyar el Programa de Registro de Texas-Glenda Dawson Donar Vida? En caso afirmativo, indicar una cantidad de la donación

5.

 

 

 

de $1 o más $

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

¿Desea registrarse como donador de órganos?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

 

 

 

¿Quieres apoyar a los sobrevivientes de asalto sexual? Si es así, porfavor indique la cantidad de donación de $1 o más $

 

 

.00 para

7.

 

 

 

ayudar a financiar la recopilación de evidencia de asalto sexual (kit de violación)

 

 

 

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

¿Desea apoyar los Veteranos de Texas? Si la respuesta es sí, por favor, indique la cantidad de su donación $

 

 

 

 

 

 

 

8.

 

 

 

¿Tiene usted alguna afección médica que le pueda impedir la comunicación con un oficial de la policía? En caso afirmativo, por favor indique

9.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(el médico debe llenar el formulario DL-101 antes de emitir una licencia de conducir o tarjeta de identificación).

 

 

 

a) Desea una insignia de Veterano en su licencia de conducir o su tarjeta de identificación? (Se requiere comprobante de baja honorable; los

 

 

 

 

b)

documentos aceptables son DD214/5, NGB22, carta de discapacidad del VA, prueba de servicio/verificación de la tarjeta de servicio honorable)

 

 

 

 

¿Es usted un Veterano que recibe 60% de compensación por discapacidad y desea quedar exento de los derechos de solicitud?

10.

 

 

 

 

(vea el punto 9a para conocer qué documentos se requieren).

 

 

 

 

 

 

 

 

En caso afirmativo, por favor indique:

 

 

 

En caso de sufrir lesiones o la muerte, ¿le gustaría proporcionar dos (2) contactos para emergencias?

 

 

 

 

a)

Nombre

 

 

 

 

 

 

 

 

 

 

 

 

 

Número telefónico

 

 

 

 

 

 

 

 

 

Domicilio

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b)

Nombre

 

 

 

 

 

 

 

 

 

 

 

 

 

Número telefónico

 

 

 

 

 

 

 

 

 

Domicilio

 

 

 

 

 

 

 

 

 

 

 

 

Para todas las Renovaciones de Licencia de Conducir, complete las preguntas MÉDICAS 11 a 17.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Las respuestas a las siguientes preguntas son para uso confidencial del Departamento.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

 

 

 

¿Tiene actualmente o alguna vez ha sido diagnosticado con o tratado por alguna enfermedad que pueda afectar su capacidad de

 

 

 

 

operar un vehículo motorizado de manera segura?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ejemplos, incluyendo pero no limitado a: Diagnóstico o tratamiento por problemas cardíacos, derrame cerebral, hemorragia o coágulos, presión arterial alta, enfisema (en los últi-

mos dos años)  enfermedad progresiva o lesión de la vista (como glaucoma, degeneración macular, etc.)  pérdida del uso normal de la mano, brazo, pie o pierna  desvanec-

imientos, ataques, pérdida de la consciencia o control del cuerpo (en los últimos dos años)

 dificultad para voltear la cabeza de un lado a otro

 pérdida de control muscular  artic-

ulaciones o cuello rígidos  coordinación inadecuada de mano/ojo  afección médica que altere su juicio  mareos o problemas de equilibrio  pérdida de algún miembro

Si respondió a la pregunta anterior, ¿su afección ha

MEJORADO o

EMPEORADO desde su última solicitud de original/renovación de licencia de conducir?

12.

 

 

 

¿Tiene usted un condición mental que puede afectar su capacidad para operar con seguridad un vehículo motorizado? Si su respuesta es si,

13.

 

 

 

por favor de explicar:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

¿Alguna vez ha tenido un ataque epiléptico, convulsión, pérdida de la consciencia u otro ataque?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

 

 

 

¿Tiene diabetes que requiera tratamiento con insulina?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

 

 

 

¿Tiene alguna dependencia del alcohol o de drogas que pudiera afectar su capacidad de operar un vehículo motorizado de manera

16.

 

 

 

segura o ha tenido algún episodio de abuso de drogas o alcohol en los últimos dos años?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

En los últimos dos años, ¿ha recibido tratamiento por alguna otra afección médica grave?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17.

 

 

 

Explique:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

¿Alguna vez ha sido remitido al Comité Asesor Médico de Licencias de Conducir de Texas?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cualquier hombre ciudadano o inmigrante de los Estados Unidos entre 18 y 26 años de edad que presente esta solicitud otorga su consentimiento para ser registrado

en el Sistema de Servicio Militar Selectivo de los Estados Unidos. Usted debe estar registrado para tener derecho a recibir ayuda federal estudiantil (incluso la beca

Pell Grant), capacitación laboral, empleo federal y la ciudadanía si es inmigrante,. En Texas, usted debe estar registrado para tener derecho a recibir ayuda estudiantil

universitaria o empleo con el Estado. No registrarse en el Servicio Militar Selectivo es un delito mayor. Si es declarado culpable de ello, podría ser castigado hasta con

cinco años de prisión y/o una multa de 250,000 dólares. Si no se ha registrado antes de cumplir 26 años, ya no se podrá registrar y podría perder permanentemente los

beneficios asociados con el registro. Para conocer otras opciones alternativas para solicitantes que se oponen al servicio militar convencional por motivos religiosos u otros

motivos de conciencia, podrá encontrar información disponible en: http://www.sss.gov/FactSheets/FSaltsvc.pdf.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Juro solemnemente, afirmo o certifico que soy la persona que se indica en el presente documento y que las declaraciones en esta solicitud son verdaderas y correctas. Además

certifico que mi domicilio de residencia es (marque una opción): (

) casa residencial, (

 

) apartamento, ( ) hotel, ( ) sitio de refugio temporal. Estoy de acuerdo en informar

inmediatamente al Departamento de Seguridad Pública de Texas cualquier cambio en mi condición médica que pueda afectar mi capacidad para conducir de manera segura

un vehículo motorizado.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DL-43 (Rev. 1/18)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRMA DEL ASPIRANTE

 

 

 

 

 

 

 

 

 

 

 

 

 

FECHA

 

 

 

 

Common mistakes

Filling out the DL-43 form can be a straightforward process, but many people make common mistakes that can lead to delays or issues with their application. One frequent error is not providing complete personal information. It’s essential to fill out every section accurately, including your full name, address, and date of birth. Omitting even one detail can result in your application being returned.

Another mistake is failing to sign the form. Many applicants overlook this crucial step, thinking that submitting the form without a signature is acceptable. However, a signature is necessary for the application to be valid. Without it, your submission may not be processed.

Inaccurate information is also a common pitfall. Some individuals may mistakenly input incorrect numbers or letters, especially when it comes to their identification numbers. Double-checking your entries can help avoid this problem. Remember, accuracy is key to ensuring your application is processed smoothly.

People often forget to check the expiration date of their documents. Submitting expired identification can lead to immediate rejection of the form. Always ensure that your ID and any supporting documents are current before submission.

Another issue arises when applicants do not follow the specific instructions outlined for the DL-43 form. Each section may have unique requirements. Ignoring these instructions can result in incomplete submissions. Taking the time to read through the guidelines carefully can save you from unnecessary complications.

Some individuals may also neglect to keep copies of their completed forms. This can be a problem if you need to reference your application later. Keeping a copy for your records is a good practice that can help you track the status of your submission.

Lastly, not paying the required fees can lead to delays. Make sure you are aware of any costs associated with your application and include the correct payment. Failing to do so can halt the processing of your DL-43 form altogether.

Similar forms

The DL-43 form is a specific document used for various purposes, primarily related to driver licensing and identification in the United States. Here are ten other documents that share similarities with the DL-43 form:

  • Driver's License Application (Form DL-1): Like the DL-43, this form is used to apply for a driver's license, requiring personal information and proof of identity.
  • State ID Application (Form DL-44): Similar to the DL-43, this form is for individuals who need a state-issued identification card instead of a driver's license.
  • Renewal Application (Form DL-42): This document is used to renew an existing driver's license, mirroring the information required in the DL-43.
  • Change of Address Form (Form DL-40): This form allows individuals to update their address on their driver's license, similar in nature to the DL-43's personal information requirements.
  • Durable Power of Attorney Form: This document allows an individual to designate someone to make decisions on their behalf, similar to how the DL-43 form verifies identity for licensing purposes. For more information, visit https://floridaformspdf.com/printable-durable-power-of-attorney-form.
  • Medical History Form (Form DL-50): This document may be required for those with certain medical conditions, similar to how the DL-43 collects health-related information.
  • Vehicle Registration Application (Form MV-1): While focused on vehicle registration, it requires personal identification, akin to the DL-43's need for identity verification.
  • Commercial Driver's License Application (Form DL-1C): This form is for obtaining a commercial driver's license and shares many identification requirements with the DL-43.
  • Temporary Driver's License (Form DL-45): Issued under specific circumstances, this form serves a similar purpose to the DL-43 in providing legal driving authorization.
  • Identity Verification Form (Form ID-1): Used for verifying identity in various contexts, this form parallels the DL-43 in its focus on personal identification.
  • Learner's Permit Application (Form DL-37): This document allows new drivers to apply for a learner's permit, requiring similar personal information as the DL-43.

Fill out Common Documents