Fillable Form Arizona Identification Card Application (40-5122)

What is the Arizona Identification Card Application form?

Form 40-5122, Driver License/Identification Card Application, or commonly referred to as the Arizona Identification Card Application form, is a state-level application form by the Arizona Department of Transportation (DOT) — Motor Vehicle Division (MVD).

Exclusive to residents of Arizona, the Arizona Identification Card Application form is used when applying for an identification card for travel and non-travel purposes. Aside from its use as a form to apply for an ID card in the state, it can also be used in applying for a driver’s license, driving permit, motorcycle driver’s license, and a limited-use driver’s license for an active duty military, student, or family member.

Where to get the Arizona Identification Card Application form?

You can download and print a copy of the Arizona Driver’s License Application form on the Arizona Motor Vehicle Division’s official website to complete manually. For your convenience, you can use an online PDF editor, such as PDFRun, to fill out the application form electronically.

How to fill out the Arizona Identification Card Application form?

Answer the two-page application form accurately to avoid any problems with your application for an identification card.

What are you applying for?

Mark the appropriate box to determine your type of application. There are two types of application: Driver License (DL) and Identification Card (ID).

Driver License (DL)

• Travel
• Standard (Non-Travel)
• Permit
• Motorcycle
• Limited (Active-duty, military, student, or family member)

Identification Card (ID)

• Travel
• Non-Travel

Have you ever had a DL/ID issued in Arizona?

Mark the Yes box if you have been previously issued a driver’s license or identification card in Arizona.

Social Security Number

Enter your nine-digit Social Security Number (SSN).

Applicant Name

Enter your full legal name in the following format: First Name, Middle Name, Last Name. This will appear on your Arizona driver’s license or identification card.

Suffix

Enter your suffix, if you have any.

Residence Street Address

Enter the full address where you live, including the Apartment or Unit Number, City, State, and Zip.

Mailing Address

Enter the full address where you want to receive your mail, if different from your residence address, including the Apartment or Unit Number, City, State, and ZIP.

Mark the Appear on License box if you want your mailing address to appear on your license, instead of your residence address.

Sex

Mark the appropriate box to determine your sex. You may select:

• Female
• Male

Weight

Enter your weight in pounds.

Height

Enter your height in feet and inches.

Eye Color

Enter your natural eye color.

Hair

Enter your natural hair color.

Date of Birth

Enter the date you were born in the following format: Month, Day, Year.

The next lines are numbered items.

Item 1

Mark Yes if you wish to register to vote or update your existing voter registration and you are a U.S. Citizen; otherwise mark No.

Mark the appropriate box if you want to be on the permanent early voting list and receive an early ballot by mail each election you are eligible.

Party Preference

Mark the box to determine which political party you want to be affiliated with. You can select:

• Republican
• Democratic
• Other — If you select this option, specify the name of the political party.

Item 2

Mark the DONOR♥ box if you want to become an organ or tissue donor and join the DonateLifeAZ Registry. By marking the box, DONOR♥ will appear on your driver’s license.

Item 3

Mark the box if you are a U.S. Military veteran who was enlisted, drafted, inducted, or commissioned to serve in the active military, naval, or air service, and was not dishonorably discharged. By marking the box, “Veteran” will appear on your driver’s license.

Item 4

Mark the box if you have a medical condition and you want to display it on your license or identification card. Proof of your medical condition is a requirement.

Item 5

Mark Yes if you have a physical, psychological, or visual condition (other than wearing corrective lenses), or alcohol/drug dependency and taking medications affecting your ability to operate a vehicle safely. The Please Explain box requires an explanation for your condition.

Item 6

Mark Yes if you have ever been determined to be incapacitated by a court.

Item 7

Mark the box if you consent to the release of your personal information contained in your driver’s license and vehicle record. By marking the box, you also understand that this is not a one-time consent that applies only to a specific individual or organization, but is instead a general consent that applies to all requests from any and all individuals or organizations for any purpose until you revoke in writing. Take note that consent for a vehicle record applies to all owners.

If you certify under penalty of perjury that the information you have provided is true and correct, sign the form to continue with your application.

Applicant Signature

Affix your signature.

Legal Guardian Certificate

This section is for driver’s license and identification card applicants. A parent or legal guardian must answer this section.

Mark the appropriate box to determine your relationship with the applicant. You can select:

1. Natural/Adoptive Parent, married to other natural/adoptive parent
2. Natural/Adoptive Parent with sole custody
3. Natural/Adoptive Parent share joint custody — This item requires the signatures of both parents.
4. Full legal guardian — Provide proof of legal guardianship.
5. Other — Provide any proof that proves your relationship with the applicant.

You must consent that you are responsible for any negligence or willful misconduct caused by the minor applicant by signing the Arizona Identification Card application form.

Parent or Guardian Name

Enter your full legal name.

Parent or Guardian Signature

Affix your signature.

Driving Practice Certificate

This is to certify that the minor applicant completed at least 30 hours of supervised driving practice, including at least 10 hours at night for a graduated driver’s license; at least 30 hours of motorcycle riding practice for a motorcycle license or motorcycle endorsement

Parent or Guardian Name

Enter your full legal name.

Parent or Guardian Signature

Affix your signature.