Fillable Form Louisiana Driver License Replacement

What is the Lousiana Driver’s License Replacement form?

The Louisiana Driver’s License Replacement form or Temporarily Residing Out of State Application for Reconstructed Duplicate/Renewal License/ID Card is a form issued by the Louisiana Office of Motor Vehicles (OMV) that residents can use to request a replacement driver’s license or identification card.

Only residents of the state of Louisiana who have a driver’s license that has been lost, stolen, or destroyed can use the Louisiana Driver’s Replacement form.

What do I need to fill out the Louisiana Driver’s License Replacement form?

The Louisiana Driver’s License Replacement form is a single-page form that requires your personal information. It also asks questions to determine your eligibility to obtain a driver’s license.

You will need to provide the following:

• Driver’s License or Identification Card Number
• Date of Birth
• Social Security Number
• Race
• Sex
• Eye Color
• Height
• Weight
• Daytime Phone Number
• Full Legal Name
• Temporary Out of State Address
• Permanent Louisiana Residence Address (including Apartment Number, City/Town, State, ZIP)

The form will also ask you a series of “Yes or No” questions, meaning you will have to know whether or not you:

1. Are you a citizen of the United States?
2. Have ever experienced any loss of consciousness other than normal sleep? If you answered yes, you will need to explain what happened.
3. Do you currently have any physical or mental condition which could impair your ability to operate a motor vehicle safely?
4. Do you wear contact lenses or glasses when driving?

If you are a minor or a child, you will also need the consent of your parent or legal guardian. You will need your parent/guardian to affix his or her signature on the form.

If you would like to request a name change, you may also provide your new name in the provided space.

How to fill out the Louisiana Driver’s License Replacement form?

Before filling out the Louisiana Driver’s License Replacement form, go through it to understand and know the information you will be providing. For your convenience, we have a list of everything you would need for this form in the previous section.

Ensure that all information that you are about to write down in this form is completely truthful and accurate. This is a government-issued document and thus should be treated with the utmost care and attention.

Reason for filling out this form

Before being asked anything else, you will be asked to provide your reason for filling out the Louisiana Driver’s License Renewal form.

Mark the purpose of why you are using the form. You may select:

• Renewal Request — Expired License/ID Card
• Duplicate Request — Lost or Stolen License/ID Card

Must Be Completed

You will be needing to provide personal information and other details to fill out this part of the Louisiana Driver’s License Renewal form.

License/ID Number

Enter your current driver’s license or ID card number.

Date of Birth

Enter your date of birth in the following format: MM/DD/YYYY.

Social Security Number

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

Race/Sex

Enter your race and sex.

Eyes

Enter your natural eye color.

Height

Enter your height.

Weight

Enter your weight.

Daytime Phone Number

Enter your daytime phone number. This is the number through which you can be contacted between the hours of 9:00 AM and 5:00 PM, but this is not required for the purpose of this form.

Full Name

Enter your full legal name, including Last Name, First Name, Middle/Maiden Name, Suffix.

Temporary Out of State Address

Enter your full temporary out-of-state address, including Apartment Number, City/Town, State, ZIP.

Permanent Louisiana Residence Address

Enter your full permanent Louisiana residence address, including Apartment Number, City/Town, State, ZIP.

Must Be Answered

This part of the form has four Yes or No questions. Mark the Yes for each item if applicable; otherwise, mark No. For item number two, if you answered Yes, you need to provide an explanation.

1. Are you a citizen of the United States?
2. Have you ever experienced any loss of consciousness other than normal sleep? If you answered yes to this question, you will have to provide an explanation
3. Do you currently have any physical or mental condition which could impair your ability to safely operate a motor vehicle?
4. Do you wear contact lenses or glasses while driving?

Must Be Complete By Parent/Guardian If Applicant is a Minor Child

If you are a minor, this section of the form should be answered. If you are not a minor, then you can skip this section.

Your guardian has to mark the box that determines his or her relationship with you. He or she may select:

• Custodial parent
• Legal domiciliary parent
• Legal guardian of the minor applying and this is my authorization to the Office of Motor Vehicles to issue a license/identification card as indicated above. I also declare by my signature below that the information furnished by minor and me is complete and correct. Signature of person authorized to sign in accordance with R.S. 32:407.

License/ID Number

Enter license or identification number.

Signature

Enter your parent or guardian’s signature above his or her legal name.

Printed Name

Enter your parent or guardian’s full legal name in the following format: First Name, Middle/Maiden Name, Last Name.

Notary Public Signature & Seal

This section needs to have the signature and seal of a notary public.

Complete for Name Change

If you have changed your name, you are allowed to place your new name on the renewed or replacement license. If you are changing your name, ensure that the appropriate documents are attached to this form.

Enter the name on your current driver’s license or identification card then, enter the new name you would want to appear on your new driver’s license or identification card.

Declaration of Intent

To verify your identity and all the information you have provided on your Louisiana Driver’s License Replacement form, enter the date of signing and affix your signature.