Application For Ignition Interlock License/Return of Regular Driver License

DL-3731 (7-25-17)
APPLICATION FOR IGNITION INTERLOCK

LICENSE/RETURN OF REGULAR DRIVER LICENSE
PLEASE READ IMPORTANT INFORMATION ON THE REVERSE SIDE.
A APPLICANT INFORMATION
DRIVER'S LICENSE NUMBER LAST NAME JR/ETC
FIRST NAME MIDDLE NAME
DATE OF BIRTH TELEPHONE NUMBER (8:00 A.M.-4:30 P.M.) E-MAIL ADDRESS (if applicable)
( )
Month Day Year
EYE COLOR (Please check one): BLUE BROWN GREEN

HAZEL
PINK BLACK GRAY DICHROMATIC OTHER_____________________
OUT-OF-STATE ADDRESS CHANGE. We may not issue driver license products to an out-of-state address, except in the case of an employee of federal or state
government, armed forces personnel, or their families, whose workplace is located outside of Pennsylvania. If this exception applies to you, please check the
appropriate box and include documentation of your status with this application.
Attach a letter from your employer on their letterhead to document your status, or attach a copy of your current Photo ID issued by your employer. If you are the
immediate family of a person meeting one of the allowable exceptions, attach the documentation of the person employed. Additionally, you must indicate your
relationship to that person.
I certify that my workplace is located out of state and I am employed by, or am the immediate family of a person employed by:
US Armed Forces Federal Government Pennsylvania State Government
Relationship to person meeting exemption (check one): Spouse Dependent Child
ADDRESS CHANGE - A Post Office Box number may be used in addition to the actual residence address, but cannot be used as the only address.
NEW
STREET
ADDRESS
CITY STATE ZIP CODE
If you are a registered voter in PA, would you like us to notify your county voter registration office of this change? YES NO
If you are not a registered voter, you may contact your county voter registration office.
Pennsylvania strongly supports organ and tissue donation because of its life-saving and life-enhancing opportunities.
ADD (Parental consent required if under 18) REMOVE
B APPLICATION OPTIONS - MUST CHECK ONE

OPTION 1 I am applying for an ignition interlock license. OR
As a result of the disqualification of my commercial driving privilege, (in accordance with Section 1617 of the PA Vehicle Code)
OPTION 2 I am applying for a non-commercial class ignition interlock license. OR
My ignition interlock period has been served and I am applying for the return of my previous classification.
OPTION 3 NOTE: If applying for the return of your previous CDL classification, after serving your disqualifications period, you must complete
form DL-100CD.
During your ignition interlock period were you given a ticket or cited for driving without an ignition interlock system and/or tampering
with an ignition interlock device? YES NO
If yes, give date when violation occurred _____________ and check one of the following:
1. I was found not guilty. 2. I paid the ticket, plead guilty or was found guilty. 3. The case hasn't been decided yet.
C REQUEST FOR EXEMPTION FROM PHOTO - ABSENTEE EXEMPTION

During the next 60 days I will be absent from PA for the following reason: Military School Work Travel
Within 45 days of my return I will apply for a driver's license containing my photo.
X
SIGN
HERE
APPLICANT'S SIGNATURE
D AUTHORIZATION AND CERTIFICATION (Sign and Enter Fee)

For Veterans wishing to add the Veterans Designation to their Driver's License or ID Card: I certify under penalty of law that I am a qualified applicant and hereby request it be
added to my product. I understand that misrepresentation will result in the cancellation of my driver's license.
I certify under penalty of law that all information given on this application is true and correct. If using a Messenger Service, I hereby authorize the Department to furnish them with
my driving record for the purpose of processing this form. I hereby acknowledge this day that I have received notice of the provisions of Section 3709 of the Vehicle Code. (See
reverse for provisions.)
I wish to contribute $1.00 to the Organ Donation Awareness Trust Fund. (see reverse)
I wish to contribute $3.00 to the Veterans' Trust Fund. (see reverse)
X
SIGN
HERE
APPLICANT'S SIGNATURE IN INK DATE
WARNING: Misstatement of Fact is a misdemeanor of the third degree punishable by a fine of up to $2,500 and/or imprisonment up to 1 year (18 Pa. C.S. Section 4904[b]).
PAID BY: Check Money Order Payable to PennDOT (PennDOT does not accept cash, credit or debit cards) TOTAL $
MESSENGER NO.
DL-3731 (7-25-17)
The most current version of this form can be found at: www.dmv.pa.gov
SECTION A - APPLICANT INFORMATION

• Complete applicant information.
• Complete address change if needed.
• Include the Driver Number if available. This assists PennDOT in the identification process
• The Department is required to obtain the Licensee's height and eye color under the provisions of Section 1510(a) of the
Pennsylvania Vehicle Code. This information will be used as identifying information in an attempt to minimize driver license fraud.
SECTION B - APPLICATION OPTIONS

• Check one block only. Indicate the type of license you are requesting.
• If you are choosing option 3, you must answer the question regarding Ignition Interlock violations. Failure to answer this question
will result in the delay of processing your application.
• Return your completed and signed application with check or money order made payable to "PennDOT", to:
FOR OPTION 1 AND OPTION 2 FOR OPTION 3

Department of Transportation Department of Transportation
Bureau of Driver Licensing Bureau of Driver Licensing
P.O. Box 68693 P.O. Box 68273
Harrisburg, PA 17106-8693 Harrisburg, PA 17106-8273
SECTION C - REQUEST FOR EXEMPTION FROM PHOTO

• Section C must be signed.
SECTION D - AUTHORIZATION AND CERTIFICATION

• Veterans Designation: You have the opportunity to add the veterans designation to your driver's license, which clearly indicates you
are a veteran of the United States Armed Forces. To qualify, you must have served in the United States Armed Forces, including a reserve
component or the National Guard, and have been discharged or released from such service under conditions other than dishonorable.
If you are requesting to add the veterans designation to your license, make sure you check the box at the top in Section D.
• Section D must be signed.
• Fill in the fee in the box provided. (see fees below)
FEES
Driver's License without Class M ..................................$29.50 Driver's License with Class M .................................................$34.50
or
If your license expires within 6 months, you may choose to renew at this time by attaching a DL-143 / DL-143CD
along with the renewal fees ONLY.
You have the opportunity to contribute $1.00 to the Fund. The additional $1.00 contribution must be added to your
ORGAN DONATION
payment. You must also check the block provided to ensure proper handling of your contribution. The ODTF provides
AWARENESS TRUST for the development and implementation of donor awareness programs and funds shall be appropriated subject to the
FUND (ODTF) approval of the Governor.
You have the opportunity to make a tax deductible contribution to the VTF. Your contribution will help support programs
VETERANS’ TRUST and projects for Pennsylvania veterans and their families. Since this additional $3.00 is not part of the fee, please add
FUND (VTF) the donated amount to your payment. Also, please check the proper block on the form to ensure your contribution is
handled properly.
Change your address or renew your driver's license online at www.dmv.pa.gov

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DL-3731 (7-25-17)

APPLICATION FOR IGNITION INTERLOCK

FIRST NAME MIDDLE NAME

EYE COLOR (Please check one): BLUE BROWN GREEN

B APPLICATION OPTIONS - MUST CHECK ONE

C REQUEST FOR EXEMPTION FROM PHOTO - ABSENTEE EXEMPTION

D AUTHORIZATION AND CERTIFICATION (Sign and Enter Fee)

SECTION A - APPLICANT INFORMATION

SECTION B - APPLICATION OPTIONS

FOR OPTION 1 AND OPTION 2 FOR OPTION 3

SECTION C - REQUEST FOR EXEMPTION FROM PHOTO

SECTION D - AUTHORIZATION AND CERTIFICATION

Change your address or renew your driver's license online at www.dmv.pa.gov

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