DMV-002E Revised 6/2021
If you were born male and are 18-26 yrs old, you will be registered for Selective Service. If you are
eligible but choose NO, you will no longer be eligible for federal student loans, grants, benefits relating
to job training, most federal jobs and, if applicable, U.S citizenship.
NO, I am not
eligible or do not
wish to register
I have a U.S. Armed Forces honorable discharge and wish to have a veteran designation placed/retained
on my license. If your card does not already have a veteran designation, you must present proof of
honorable discharge.
Have you ever served on active duty in the Armed Forces of the United States and separated from such
service under conditions other than dishonorable?
Have you ever been assigned to duty for a minimum of 6 continuous years in the National Guard or a
reserve component of the Armed Forces of the United States and separated from such service under
conditions other than dishonorable?
Have you ever served the Commissioned Corps of the United States Public Health Service or the
Commissioned Corps of the National Oceanic and Atmospheric Administration of the United States in the
capacity of a commissioned officer while on active duty in defense of the United States and separated
from such service under conditions other than dishonorable?
STOP
You will fill this out with the DMV Representative so they can witness your signature
CONSENT FOR MINOR’S LICENSE: I consent to the issuance of an instruction permit/license to , whose
relationship to me is . I understand I can be held responsible for any liability caused by his/her
negligence or willful misconduct in the operation of a motor vehicle (NRS 483.300 and/or NRS 486.101). I understand I may have the
permit/license cancelled & be released from liability by signing a cancellation request. I understand, before a license is issued, he/she may
need to present a DMV-301 Certification of Attendance, a Certificate of Completion from a Nevada DMV-approved Driver Education
Course, & a DLD-130 Beginning Driver Experience Log attesting he/she has completed at least 50 hours of behind-the-wheel driving
experience.
Initial _____________
INSTRUCTION PERMIT: I certify that I understand my instruction permit is valid for up to one (1) year from date of
issuance and I must carry it with me when I am driving. I understand the restrictions of my permit and agree to
follow them.
MINOR ORGAN DONOR: I, parent/guardian of minor applicant, understand unless the anatomical gift is amended
or revoked by the donor before his/her death, I may not amend or revoke the anatomical gift.
Parent/Guardian Signature
NON-USE OF NEVADA DRIVING PRIVILEGE: I have not operated a motor vehicle since: _______Date
NO SOCIAL SECURITY NUMBER: I certify I have never been assigned a Social Security Number under the
provisions of the Social Security Act of the United States.
DISCLOSURE STATEMENTS:
*The Privacy Act of 1974 is a federal law authorizing the use of your Social Security Number to verify identity. You are
required to submit your Social Security Number so the state may administer laws related to licensing drivers (NRS 483.290).
The driver’s license or identification card application you are submitting will cause any driving record from your previous state
to be transferred to Nevada and will show as surrendered. NRS 482.385 requires you to register each vehicle you own and
operate within 30 days of becoming a resident.
I hereby certify, under penalty of perjury, that all statements in this application are true and correct. I understand that any and all
other driver’s licenses or identification cards issued by any other jurisdiction will be surrendered upon issuance of a Nevada
license or identification card. I agree and understand that any misstatement of material facts may cause cancellation and/or
denial of my 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_________________________
Parent/Guardian Signature if Applicant is under 18 ______________________________________ DL/ID_______________________
Sworn before me this ___________________ Day of ___________________________________________20____________________
Authorized DMV Representative/Notary Public ______________________________________________________________________
Signatures must be originals. Photocopies are not acceptable. Changes may not be made to this form once signed.