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I I
APPLICATION FOR INTERNATIONAL DRIVING PERMIT
or
INTER-AMERICAN DRIVING PERMIT
FEE FOR EACH PERMIT $10.00
Issuance of Permit is restricted to persons EIGHTEEN YEARS or over who hold a valid U.S.A. or Territorial License. PERMIT
VALID FOR ONE YEAR. Not renewable.
CHECK DESIRED PERMIT
International Driving Permit (Fee $10.00 and 2 Passport Type Photos signed on back)
Inter-American Driving Permit *** (see reverse side) (Fee $10.00 and 2 Passport Type Photos signed on back)
MANDATORY REQUIREMENTS
(1) Attach 2 recent signed Passport Type Photos (2" x 2")
(2) Enclose permit fee of $10.00 (NO CASH)
(3) If mailing application, a photocopy of U.S. Driver's License must accompany completed application.
NOTE: IT IS IMPORTANT THAT YOUR U.S.A. OR TERRITORIAL LICENSE BE CARRIED WITH THE PERMIT
AT ALL TIMES. The International or Inter-American Permit is not valid for driving in the United States.
PRINT NAME IN FULL. No Initials
Mr. Mrs. Ms. (Circle One)
FIRST__________________________MIDDLE______________________________LAST_____________________________________________________________
PHONE_______________________________________HOME STREET ADDRESS__________________________________________________________________
CITY______________________________________________________________STATE___________________________________ZIP CODE__________________
U.S. DRIVER'S LICENSE NO.__________________________________________STATE OF ISSUE_____________________EXPIRATION DATE______________
BIRTHPLACE:
CITY________________________________________________________STATE OR COUNTRY_____________BIRTH DATE (MO . DAY YEAR)_____________
DATE PERMIT TO BE EFFECTIVE_______________________________________DEPARTURE DATE FROM U.S.______________________________________
FOREIGN ADDRESS (If known)___________________________________________________________________________________________________________
PLEASE CHECK THE APPROPRIATE BOX BELOW TO INDICATE THE TYPE OF VEHICLE FOR WHICH YOU NOW
HOLD A VALID U.S.A. OR TERRITORIAL DRIVER'S LICENSE, AND FOR WHICH YOU DESIRE THIS PERMIT:
MOTORCYCLE
PASSENGER CAR
VEHICLE OVER 7,700lbs
VEHICLE OVER 8 SEATS
VEHICLE WITH HEAVY TRAILER
I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT, AND THAT THE LICENSE INDICATED HAS NOT BEEN SUSPENDED NOR REVOKED.
I FURTHER CERTIFY THAT I UNDERSTAND THAT A VALID STATE DRIVER'S LICENSE MUST ACCOMPANY THIS PERMIT, AND THAT THIS PERMIT IS
VALID ONLY AS LONG AS THE STATE LICENSE IS VALID, BUT NOT TO EXCEED ONE YEAR FROM THE DATE THE PERMIT IS ISSUED.
SIGNATURE_____________________________________________________DATE_________________________________
(signature mandatory for issuance of Permit)