Microsoft Word - TC 94-192.docx

KENTUCKYTRANSPORTATIONCABINET

DepartmentofVehicleRegulation

DIVISIONOFDRIVERLICENSING

TC94‐192

Rev.03/2022

Page1of1

DRIVERLICENSE/IDCARDRENEWAL

NOTE:ThisformdoesnotapplytoCDLlicenses,non‐UScitizens,orapplicantswhorequiretesting(driverorvision).

SECTION1:APPLICANTINFORMATION

FULLLEGALNAME(Print) EMAIL CELLPHONE#

IagreetoreceiveemailortextmessagesconcerningKYTCDriverLicensingnotifications.

STREETADDRESS CITY STATE ZIP

MAILINGADDRESS(ifdifferentfromstreetaddress) CITY STATE ZIP

Ifchangeinaddress,pleaseprovide1proofofaddresspostmarkedwithinayear.Proofsofaddressincludehomeutilitybill,

rentalagreement,bankstatement,phonebill,etc.SeeIDOCUMENTGUIDEforcompletelistofdocuments.

DATEOFBIRTH(mm/dd/yyyy) DRIVERLICENSE#/SSN#(last4digitsofSSN) EXPIRATION(mm/dd/yyyy)

SECTION2:ITEM&PAYMENTINFORMATION

(Selecttheitemyouwishtorenew.)Only4‐yearrenewalsareavailableviamail‐inrenewalatthistime.

TestingisrequiredifanyDriver/OperatorLicensehasbeenexpiredforlongerthanone(1)year.



StandardDriverLicense($21.50) StandardCombinationMotorcycle&OperatorLicense($26.50)

StandardIDCard($11.50) StandardorRealIDDuplicate/Replacement($15.00)‐newaddressdocumentationrequired

REALIDDriverLicense($24.00)‐onlyapplicabletocurrentREALIDDriverLicenseholders

REALIDIdentificationCard($14.00)‐onlyapplicabletocurrentREALIDIdentificationCard holders

REALIDCombinationMotorcycle&OperatorLicense($29.00)‐onlyapplicabletocurrentREALIDCombination

Motorc

cle&O

eratorLicenseholders

WouldyouliketodonatetotheTrustforLifeOrganDonationProgram? No $2 $5 $10 $25

Formofpayment: cash moneyorder check(MakecheckspayabletoKentuckyStateTreasurer.)

debit/creditcard(Apro cessingfeeof1.5%fordebitand2.75%forcreditwillbeadded.)

Ifpayingwithadebit/creditcard,providethefollowinginformation:

NAMEONCARD(exactlyasitappears) CARD# EXPIRATION(mm/yy)SECURITYCODE(3digitsonback)

SECTION3:APPLICANTSTATUSQUESTIONS

1.AreyouaU.S.citizen? Yes No

1a.IfyouarenotaU.S.Citizen,areyouaPermanentResident? Yes No

2.

Haveyousufferedaseizureorblackoutwithinthepast90days?

Yes No



rovidethedateof

ourlastseizure. 

  



MM DD YYYY

3.

Isyourdrivingprivilegesuspendedorrevokedinanystateorjurisdiction?

Yes No

4.

Doyou haveanyphysical/mentalimpairmentsthataffectyourdri vingabilitiesorhaveyouhadablackout

withinthepastthree(3)years?

Yes No

5.

IfapplyingforaduplicateKYlicenseorKYIDcard,wassaidlicenseorIDcardlostorstolen?

Yes No

6.Doyoucurrentlyhavealicenseoridentificationcardfromanotherstateorjurisdiction? Yes No

SECTION4:APPLICANTATTESTATION&SIGNATURE

I affirm that I am the person named and described in the KY Drivers Licensing Information System and the statements

providedinthisapplicationandtothelicensingofficialsaretrueandcorrecttothebestofmyknowledge.Iunderstandthat

misrepresentationinthelicensingprocesscanresultincriminalandcivilpenaltiesunderstateandfederallaw.

APPLICANTSIGNATURE(Signinblackinkortypename.) DATE

INSTRUCTIONS:Submitthisapplicationandpaymentbymailordropboxlocatedatthebelowaddress.

Mail and drop box address: Kentucky Transportation Cabinet, Division of Driver Licensing, 200 Mero Street, Frankfort

KY 40622 If you have questions or need assistance with this form please call (502) 564-1257.

If you would like to register to vote, please visit https://vrsws.sos.ky.gov/ovrweb/.