Unformatted text preview: a visual, physical or psychological condition, alcohol/drug dependency or are you taking any medications that could
affect your ability to drive? (driver license applicants only) Please Explain Yes No Have you ever been determined to be incapacitated by a court? (driver license applicants only) Yes No Are you a United States citizen who wishes to register to vote or update your existing voter registration? I want to be placed on the permanent early voting list and receive an early ballot by mail for each election I am eligible. Party Preference I want to be an organ and tissue donor. By checking this box, Donor Network of AZ will add me to the Donate Life AZ Registry. All Applicants: I certify that the information above is true and correct. I understand that I must report a change of address or name to MVD within 10
days. All Driver Applicants: I understand the laws, rules and regulations described in the Arizona Driver License Manual, and that I must report to
MVD in writing, within 10 days, any medical condition that develops or worsens that may affect my ability to safely operate a motor vehicle.
Male Applicants Under 26: By submitting this application, I consent to registration wit...
View Full Document
- Spring '07
- Driver's license, driver license, MVD Agent Signature, MVD Agent