Free 45811.FH11 - Indiana

REQUEST FOR PHOTO EXEMPT LICENSE / ID TEMPORARY OR VERIFICATION
State Form 45811 (R7 / 6-07) Approved by State Board of Accounts, 2007

Reset Form

Mail to: INDIANA BUREAU OF MOTOR VEHICLES Photo-Exempt Request 531 Virginia Avenue Indianapolis, IN 46203

Check the appropriate box(es) that applies: BUSINESS COLLEGE MILITARY MISSIONARY RELIGIOUS

FIRST ISSUANCE (Religious only) EXTENSION / TEMPORARY RENEWAL DUPLICATE VERIFICATION LETTER

NOTE: Commercial Driver License (CDL) does not qualify for Photo Exempt. FEES:

PPC / MC CHAUFFEUR / MC OPERATOR / MC OPERATOR CHAUFFEUR PPC IDENTIFICATION CARD (Religious only)

Determine the appropriate fee on the BMV website at http://www.in.gov/bmv/fees/driverlicense.htm.

PLEASE NOTE: Extensions or verification letters do not require a fee. If your driver license is expired, you must include an additional five dollars ($5.00) delinquent fee unless you have an active military status. Please make your check or money order payable to the BMV.
SUPPORTING DOCUMENTATION IS REQUIRED FOR ISSUANCE OF A PHOTO EXEMPT LICENSE. PLEASE READ CAREFULLY AND NOTE THE FOLLOWING:

ACTIVE MILITARY: COLLEGE STUDENTS: BUSINESS: MISSIONARY:

You and / or your spouse will need a letter on letterhead verifying your status and location, out of state / country with the military, signed by your commanding officer. You will need a letter on school letterhead verifying your status and location with the college and verifying your length of stay, out of state / country, signed by the school. You will need a letter of certification on letterhead, stating your place of business and location, out of state / country, signed by management. You will need a letter on letterhead verifying your status and location, out of state / country with the church or ministry organization, signed by an organization representative. If you find that your driver license has expired while you are out to the state or country, you may request a temporary license that will allow an extension of your driver license for up to ninety (90) days from the date of expiration. If your driver license has been lost or stolen and you are outside of the state and your driver license is VALID and has not expired, you may request one (1) ninety (90) day verification letter. This letter may enable you to return to Indiana to apply for a duplicate license. You must attach a letter certifying your religious belief from your Minister, Bishop, Elder or other leader of the religious sect of which you are a member, explaining why you qualify for a photo-exempt driver license or ID card. The letter of certification MUST be on original letterhead and signed as stated above. Failure to provide such letter will result in denial of this application.
Date of expiration (month, day, year)

TEMPORARY LICENSE:

VERIFICATION LETTER:

PHOTO-EXEMPT DRIVER LICENSE OR IDENTIFICATION CARD (for Religious reasons only)
Complete the following entirely
Drivers license number Legal name (first, middle initial, last)

Indiana address (number and street, city, and ZIP code) (NOTE: Proof of residency is required to change Indiana address) Eye color Sex Date of return to Indiana (month, day, year) Hair color Date of birth (month, day, year) Height Contact telephone number Weight

(

)

Social Security number (mandatory for internal records)

Out of state since (month, day, year)

T emporary out of state / country address (number and street, city, state, country, and ZIP code)

PLEASE COMPLETE REVERSE SIDE

FALSE STATEMENTS MAY RESULT IN THE SUSPENSION OF YOUR DRIVING PRIVILEGES FOR ONE YEAR Please consider the past four years regarding any application you may have made for a driver license, learner permit, identification card or commercial driver license, when answering the following questions: Yes Yes No No 1. 2. Are you subject to fainting spells or seizures of any kind? Have you had or do you presently have a physical, mental, or hearing disability which MAY adversely affect or impair your ability to operate a motor vehicle safely? Are your driving privileges suspended, revoked, or otherwise withdrawn in this state or any other state? Where? Reason? Yes No 4. Have you ever been convicted of a felony under the motor vehicle laws of this state, or any other felony in the commission of which a motor vehicle was used? Has the information on any source document upon which your operators license was issued changed or been altered since the prior issuance of the operators license? When?

Yes

No

3.

Yes

No

5.

If you have any further questions, please feel free to contact this office at (317) 234-0554.

Read carefully and sign the following.

I do swear or affirm that all statements made throughout this application are true. False statements may result in the suspension of your driving privileges for one (1) year.
Signature of requester Date signed (month, day, year)