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Proof Of DC Residency Application Form. This is a District Of Columbia form and can be use in Department Of Motor Vehicle Statewide.
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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
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