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DL-43 Template

The DL-43 form is a document used by individuals applying for a replacement or duplicate driver's license in the state of Pennsylvania. This form helps streamline the process, ensuring that applicants provide the necessary information to obtain their new license. Understanding how to properly fill out the DL-43 can save time and reduce potential delays in receiving a replacement license.

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The DL-43 form plays a crucial role in the process of obtaining a Pennsylvania driver's license for individuals who are not U.S. citizens. This form serves as an application for a non-U.S. citizen to secure a driver's permit or license, ensuring that all necessary information is collected and verified. It includes personal details such as the applicant's name, address, and date of birth, along with information regarding their immigration status. Additionally, the DL-43 form requires documentation to establish identity and residency, which may include a passport, visa, or other legal documents. Understanding the requirements and implications of this form is essential for non-citizens looking to navigate the complexities of driving legally in Pennsylvania. By providing a clear framework for applicants, the DL-43 form not only facilitates the licensing process but also emphasizes the importance of compliance with state regulations and safety standards on the road.

Key takeaways

When filling out and using the DL-43 form, it is essential to keep several key points in mind to ensure a smooth process. Here are some important takeaways:

The DL-43 form is primarily used for applying for a Pennsylvania driver's license or ID card.
Ensure that all personal information is accurate and up to date to avoid delays.
Gather necessary documents before starting the application, such as proof of identity and residency.
Double-check the form for any errors or omissions before submission.
Submit the completed form at a local Department of Transportation (PennDOT) office or online, if available.
Be aware of any fees associated with the application process and have payment ready.
Keep a copy of the submitted form for your records.
Check the status of your application if you do not receive confirmation within the expected timeframe.
Contact PennDOT for assistance if you encounter any issues during the application process.

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Documents used along the form

The DL-43 form is an important document used for various purposes, particularly in the context of driver's licenses and identification in the United States. However, there are several other forms and documents that are often used in conjunction with the DL-43. Understanding these documents can help streamline the application process and ensure that you have everything you need. Below is a list of commonly associated forms and documents.

Application for a Driver's License (DL-1): This is the initial application form that individuals fill out when applying for a new driver's license. It collects personal information, including name, address, and date of birth.
Homeschool Letter of Intent: This form is crucial for parents wishing to homeschool their children. For more details, visit californiadocsonline.com/homeschool-letter-of-intent-form.
Vision Test Report (DL-180): A document that certifies an individual's vision meets the state’s requirements for driving. This report is often required for new applicants or those renewing their licenses.
Proof of Identity Documents: These can include a birth certificate, passport, or Social Security card. They are necessary to verify the applicant's identity and eligibility for a driver's license.
Residency Verification Form: This form proves that the applicant resides in the state where they are applying for a license. It may require documentation like utility bills or lease agreements.
Driver's Education Certificate: For new drivers, especially minors, proof of completing a driver's education course may be required. This certificate demonstrates that the individual has received the necessary training.
Medical Examination Report (DL-49): In some cases, a medical examination may be required to ensure that the applicant is fit to drive. This report is filled out by a licensed medical professional.
Renewal Application Form: When an individual’s driver's license is expiring, they must complete a renewal application. This form updates any personal information and reaffirms eligibility to drive.

Having these documents prepared can significantly ease the process of obtaining or renewing a driver's license. Each document serves a specific purpose and contributes to ensuring that all applicants meet the necessary requirements to drive safely and legally. Always check with your local Department of Motor Vehicles for the most accurate and updated information regarding required forms and documents.

Dos and Don'ts

When filling out the DL-43 form, it is important to approach the task with care. Here are some guidelines to help you navigate the process effectively.

Do: Read the instructions thoroughly before starting. Understanding the requirements can prevent mistakes.
Do: Use clear and legible handwriting or type the information if possible. This ensures that your responses are easily readable.
Do: Double-check all entries for accuracy. Taking a moment to verify can save time and prevent delays.
Do: Submit the form before the deadline. Timely submission is crucial for processing your request.

Don't: Leave any required fields blank. Incomplete forms may lead to rejection or delays.
Don't: Use correction fluid or tape on the form. This can make your submission look unprofessional and may cause issues.
Don't: Provide false information. Honesty is essential, as inaccuracies can have serious consequences.
Don't: Forget to sign and date the form. An unsigned form is considered invalid and will not be processed.

By following these dos and don'ts, you can ensure a smoother experience when completing the DL-43 form.

Common mistakes

When individuals fill out the DL-43 form, a number of common mistakes can occur. These errors often lead to delays in processing or even rejection of the application. One frequent mistake is failing to provide complete personal information. Many applicants overlook sections that require their full name, address, or date of birth. Omitting any detail can create confusion and hinder the processing of the form.

Another common error involves incorrect identification of the purpose of the application. Applicants sometimes select the wrong category or fail to specify the intended use of the form. This misidentification can lead to significant delays, as the reviewing authority may need to seek clarification or additional information.

Inaccurate or outdated information is also a prevalent issue. Some individuals do not update their details, such as their address or marital status, before submitting the form. This oversight can result in correspondence being sent to the wrong location, complicating the application process further.

Many applicants neglect to read the instructions thoroughly. The DL-43 form comes with specific guidelines that outline how to fill it out correctly. Ignoring these instructions can lead to mistakes in the way the form is completed, resulting in unnecessary complications.

Another mistake involves the failure to sign and date the form. A signature is a crucial component of the application, and without it, the form is considered incomplete. Additionally, not dating the form can raise questions about the timeliness of the application.

Applicants often forget to double-check their work before submission. Simple typographical errors, such as misspelled names or incorrect numbers, can create significant issues. Taking a moment to review the completed form can prevent these easily avoidable mistakes.

Finally, individuals sometimes submit the form without including the required supporting documents. Each application may require specific documentation to verify the information provided. Failing to include these documents can lead to delays or outright denial of the application.

File Characteristics

Fact Name	Description
Purpose	The DL-43 form is used for applying for a duplicate driver's license in certain states.
Governing Law	In Pennsylvania, the DL-43 form is governed by Title 75 of the Pennsylvania Consolidated Statutes.
Eligibility	Individuals who have lost their driver's license or had it stolen can apply using this form.
Required Information	The form typically requires personal information such as name, address, and date of birth.
Filing Fee	There is usually a fee associated with submitting the DL-43 form for a duplicate license.
Submission Method	The completed DL-43 form can often be submitted in person at a local Department of Motor Vehicles office.

Form Sample

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?

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

transfer this information to the Texas Secretary of State.

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

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

Would you like to register as an organ donor?

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

of sexual assault evidence collection kits (rape kits).

.00

Do you want to support Texas Veterans?

If yes, please indicate your donation amount $

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

(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

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:

Name

Telephone Number

Address

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)

SI NO

¿Es usted ciudadano de los Estados Unidos?

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

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?

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

de $1 o más $

.00

¿Desea registrarse como donador de órganos?

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

.00 para

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 $

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

(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

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?

Nombre

Número telefónico

Domicilio

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 SÍ 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