Proof Of DC Residency Application Form. This is a District Of Columbia form and can be use in Department Of Motor Vehicle Statewide.
Tags: Proof Of DC Residency Application, District Of Columbia Statewide, Department Of Motor Vehicle
GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT OF MOTOR VEHICLES PROOF OF DC RESIDENCY APPLICATION APPLICANT INFORMATION Last Name First Name Address Middle Name Apt/Unit Number Suffix City/State Zip Code WASHINGTON, DC Telephone Number with Area Code E-mail Address CERTIFIER INFORMATION Last Name Address First Name Middle Name Apt/Unit Number Suffix City/State Zip Code WASHINGTON, DC Relationship Telephone Number with Area Code DC Driver License or DC Identification Card Number E-mail Address Expiration Date Certifier must sign this form attesting that the above applicant resides with the Certifier in the District of Columbia. The Certifier must also provide a valid DC Driver License or valid DC Identification Card reflecting the Certifier’s name and address listed above AND one (1) of the following proof of residency documents reflecting Certifier’s name and DC address. If Certifier doesn’t have a valid DC Driver License or valid DC Identification Card, he/she can provide a valid Passport plus two (2) of the items listed below: Utility bill (water, gas, electric, oil or cable): provide entire bill issued within 60 days Valid Homeowner or Renter insurance policy reflecting name and DC address Telephone bill (no cell phone or pager bills accepted): provide entire bill issued within 60 days DC Property Tax bill issued within the last 12 months Lease or rental agreement issued within the last 2 years with the name of the Certifier as a lessee or renter Deed or Settlement Statement Any person using a fictitious name or address and knowingly making any false statement on this application is in violation of DC Law and subject to a fine of not more than $1,000 or 180 days imprisonment or both. (D.C. Official Code §22-2405) I hereby certify that the information contained on this application is true and correct. Applicant’s Signature: Date: _______________ Certifier’s Signature: Date: _______________ FOR DMV OFFICIAL USE ONLY DMV EXAMINER SIGNATURE:___________________________________________DATE:____________ Visit our website: www.dmv.dc.gov or call 311 in DC or 202-737-4404 for additional information. To report waste, fraud, or abuse by any DC Government Agency or official, call the Office of the DC Inspector General at 1-800-521-1639. DC DMV-PRA-001 Revised 07/22//09 American LegalNet, Inc. www.FormsWorkFlow.com