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    Rescind DMV Contract PDF

    Uploaded by

    MaryUmbrello-Dressler
    This document is a request form for cancelling or surrendering a driver's license or identification card from the California Department of Motor Vehicles. It collects information about the person whose license/ID is being cancelled such as their name, address, license/ID number, and date of birth. It asks for the reason for cancellation/surrender and has additional questions if the license belongs to a minor. The person completing the form must sign and provide their address, and a DMV employee will also sign with their ID number and date upon processing the request.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Rescind DMV Contract PDF

    Uploaded by

    MaryUmbrello-Dressler
    626 views1 page
    This document is a request form for cancelling or surrendering a driver's license or identification card from the California Department of Motor Vehicles. It collects information about the person whose license/ID is being cancelled such as their name, address, license/ID number, and date of birth. It asks for the reason for cancellation/surrender and has additional questions if the license belongs to a minor. The person completing the form must sign and provide their address, and a DMV employee will also sign with their ID number and date upon processing the request.

    Original Title

    306676369-Rescind-DMV-Contract.pdf

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    © © All Rights Reserved

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    This document is a request form for cancelling or surrendering a driver's license or identification card from the California Department of Motor Vehicles. It collects information about the person whose license/ID is being cancelled such as their name, address, license/ID number, and date of birth. It asks for the reason for cancellation/surrender and has additional questions if the license belongs to a minor. The person completing the form must sign and provide their address, and a DMV employee will also sign with their ID number and date upon processing the request.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    626 views1 page

    Rescind DMV Contract PDF

    Uploaded by

    MaryUmbrello-Dressler
    This document is a request form for cancelling or surrendering a driver's license or identification card from the California Department of Motor Vehicles. It collects information about the person whose license/ID is being cancelled such as their name, address, license/ID number, and date of birth. It asks for the reason for cancellation/surrender and has additional questions if the license belongs to a minor. The person completing the form must sign and provide their address, and a DMV employee will also sign with their ID number and date upon processing the request.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    142

    REQUEST FOR CANCELLATION OR DMV USE ONLY


    A Public Service Agency SURRENDER OF A DRIVER LICENSE OR Doubled From___________________
    IDENTIFICATION CARD To ___________________

    NAME OF PERSON AS SHOWN ON THE LICENSE OR IDENTIFICATION CARD TO BE CANCELLED

    Information about the


    document being ADDRESS CITY STATE ZIP CODE

    cancelled or
    surrendered LICENSE OR ID CARD NUMBER TO BE CANCELLED DATE OF BIRTH LOCATION OF LICENSE

    Lost/destroyed Attached Other (explain on reverse)

    Voluntary surrender or I voluntarily surrender and request the cancellation of my: Driver License (DL) or Identification Card (ID)
    cancellation of a
    DL or ID Card Reason for the cancellation or surrender: ________________________________________________
    Is the license in the minor’s possession? .................... Yes No
    Is there a change in the custody of the minor? ............ Yes No
    Person cancelling minor
    child’s application or I certify under penalty of perjury under the laws of the state of California that:
    (check one) I signed the minor’s application for a license.
    driver license
    I did not sign the application but I gave written consent to the issuance of the minor’s license.
    I did not sign the application but now have custody of the minor.
    PRINT YOUR NAME

    Signature of person SIGNATURE

    completing the form


    ADDRESS

    SIGNATURE OF EMPLOYEE AND ID NUMBER OFFICE NUMBER DATE


    DMV Employee
    DL 142 (REV 8/93) WWW

    CUT ON LINE AND KEEP THIS PART FOR YOUR RECORDS

    142
    REQUEST FOR CANCELLATION OR DMV USE ONLY
    A Public Service Agency SURRENDER OF A DRIVER LICENSE OR Doubled From___________________
    IDENTIFICATION CARD To ___________________

    NAME OF PERSON AS SHOWN ON THE LICENSE OR IDENTIFICATION CARD TO BE CANCELLED

    Information about the


    document being ADDRESS CITY STATE ZIP CODE

    cancelled or
    surrendered LICENSE OR ID CARD NUMBER TO BE CANCELLED DATE OF BIRTH LOCATION OF LICENSE

    Lost/destroyed Attached Other (explain on reverse)

    Voluntary surrender or I voluntarily surrender and request the cancellation of my: Driver License (DL) or Identification Card (ID)
    cancellation of a
    DL or ID Card Reason for the cancellation or surrender: ________________________________________________
    Is the license in the minor’s possession? .................... Yes No
    Is there a change in the custody of the minor? ............ Yes No
    Person cancelling minor
    child’s application or I certify under penalty of perjury under the laws of the state of California that:
    (check one) I signed the minor’s application for a license.
    driver license
    I did not sign the application but I gave written consent to the issuance of the minor’s license.
    I did not sign the application but now have custody of the minor.
    PRINT YOUR NAME

    Signature of person SIGNATURE

    completing the form


    ADDRESS

    SIGNATURE OF EMPLOYEE AND ID NUMBER OFFICE NUMBER DATE


    DMV Employee
    DL 142 (REV 8/93) WWW

    Print Clear Form

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