PLEASE STOP AND TAKE THE COMPLETED FORM TO AN EXAMINER
FAILURE TO TRUTHFULLY COMPLETE QUESTIONS MAY RESULT IN WITHDRAWAL OF DRIVING PRIVILEGE OR IDENTIFICATION CARD.
By submitting this application, I am consenting to registration with the Selective Service System, if required by federal law. Refusal to consent to the release of information to the Selective Service System shall result in the denial of the license and/or identification card.
Implied Consent - By operating a motor vehicle in this state you have given consent to a chemical test of your breath, blood, urine, or oral fluids for the purpose of determining if you are operating or in actual physical control of a motor vehicle while having a blood or breath alcohol content or are under the influence of drug or a combination of both that is prohibited by Utah law.
ID AFFIDAVIT: I, the undersigned, under penalty of perjury affirm that I am the applicant described on this application and that the information entered herein is true and correct to the best of my knowledge. I acknowledge cancellation and surrender to the Driver License Division, where possible, of any previously issued license certificates or ID cards.
X_______________________________________________________________________ hereby affirmed __________ day of _______________ 20 _____
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I, ____________________________________ give permission for the described applicant, who is under 16 years of age, to obtain a Utah Identification card.
Parent/Legal Guardian
DL AFFIDAVIT: I, the undersigned, under penalty of perjury affirm that I am the applicant described on this application and that the information entered herein is true and correct to the best of my knowledge. I acknowledge cancellation and surrender to the Driver License Division, where possible, of any previously issued license certificates or ID cards. I hold harmless the State of Utah, its political subdivisions and employees for damage or injury that may occur during a driving test, should one or more be required of me. I agree I will all the State of Utah to administer any additional driving skills tests at any future date in order to demonstrate my ability to operate a motor vehicle.
X_______________________________________________________________________ hereby affirmed __________ day of _______________ 20 _____
ASSUMPTION OF LIABILITY FOR MINORS UNDER EIGHTEEN YEARS OF AGE: I, the undersigned, under penalty of perjury state that I have read the statements made in this application and that they are true and correct to the best of my knowledge. I hereby consent to assume the obligation imposed under Section 53-3-211 Utah Code Annotated 1953 as amended, of being jointly and severally liable with the applicant for any damages caused by his/her negligence or willful misconduct while he/she is under the age of eighteen years while driving a vehicle upon a highway.
X_______________________________________________________________________ hereby affirmed __________ day of _______________ 20 _____
I CERTIFY THAT: Said applicant has completed 40 hours of driving, of which at least ten hours were after sunset, in compliance with Utah Code Annotated Section 53-3-211 or 53-3-210.5 Utah Code Annotated 1953 as amended.
X_______________________________________________________________________ hereby affirmed __________ day of _______________ 20 _____
CDL AFFIDAVIT: I hereby state, under penalty of perjury affirm that I am the applicant described on this application and that the information entered herein is true and correct to the best of my knowledge. I am of legal age to obtain the driver license for which I have applied, and that I have been a licensed driver for at least one year. I acknowledge cancellation and surrender to the Driver License Division, where possible, of any previously issued license certificates or ID cards. I hold harmless the State of Utah, its political subdivisions and employees for any damage or injuries that may occur during, or as a result of my driving skills test(s). I agree I will allow the State or Federal Government to administer any additional Pre-Trip, Basic Control Skills, and On-Road Driving tests at any future date in order to demonstrate my ability to operate a commercial motor vehicle. I certify that I meet all requirements in 49 CFR Part 383.73 and that my driving privilege is not suspended, disqualified, revoked or denied in this or any other state.
X_______________________________________________________________________ hereby affirmed __________ day of _______________ 20 _____
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