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    Rescind DMV Contract

    Uploaded by

    Noah Body
    This document is a request form for cancelling or surrendering a driver's license or identification card. It collects information about the license or ID being cancelled such as the name, address, license/ID number and date of birth of the person it belongs to. It asks for the reason for cancellation and if a minor is involved, it asks if the license is in their possession and if custody has changed. The form must be signed by the person requesting the cancellation and dated by the DMV employee processing it.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Rescind DMV Contract

    Uploaded by

    Noah Body
    13K views1 page
    This document is a request form for cancelling or surrendering a driver's license or identification card. It collects information about the license or ID being cancelled such as the name, address, license/ID number and date of birth of the person it belongs to. It asks for the reason for cancellation and if a minor is involved, it asks if the license is in their possession and if custody has changed. The form must be signed by the person requesting the cancellation and dated by the DMV employee processing it.

    Original Description:

    Rescind your dmv contract in california with this form

    Copyright

    © © All Rights Reserved

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    This document is a request form for cancelling or surrendering a driver's license or identification card. It collects information about the license or ID being cancelled such as the name, address, license/ID number and date of birth of the person it belongs to. It asks for the reason for cancellation and if a minor is involved, it asks if the license is in their possession and if custody has changed. The form must be signed by the person requesting the cancellation and dated by the DMV employee processing it.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    13K views1 page

    Rescind DMV Contract

    Uploaded by

    Noah Body
    This document is a request form for cancelling or surrendering a driver's license or identification card. It collects information about the license or ID being cancelled such as the name, address, license/ID number and date of birth of the person it belongs to. It asks for the reason for cancellation and if a minor is involved, it asks if the license is in their possession and if custody has changed. The form must be signed by the person requesting the cancellation and dated by the DMV employee processing it.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    142

    REQUEST FOR CANCELLATION OR


    SURRENDER OF A DRIVER LICENSE OR
    IDENTIFICATION CARD

    A Public Service Agency

    DMV USE ONLY


    Doubled From___________________
    To ___________________

    NAME OF PERSON AS SHOWN ON THE LICENSE OR IDENTIFICATION CARD TO BE CANCELLED

    Information about the


    document being
    cancelled or
    surrendered

    ADDRESS

    CITY

    STATE

    LICENSE OR ID CARD NUMBER TO BE CANCELLED DATE OF BIRTH

    LOCATION OF LICENSE

    Lost/destroyed

    Attached

    ZIP CODE

    Other (explain on reverse)

    Voluntary surrender or I voluntarily surrender and request the cancellation of my:


    Driver License (DL) or
    Identification Card (ID)
    cancellation of a
    Reason for the cancellation or surrender: ________________________________________________
    DL or ID Card
    Is the license in the minors possession? ....................
    Is there a change in the custody of the minor? ............

    Yes
    Yes

    No
    No

    Person cancelling minor


    childs application or I certify under penalty of perjury under the laws of the state of California that:
    (check one)
    I signed the minors application for a license.
    driver license

    I did not sign the application but I gave written consent to the issuance of the minors license.
    I did not sign the application but now have custody of the minor.

    PRINT YOUR NAME

    Signature of person
    completing the form

    SIGNATURE

    ADDRESS

    DMV Employee

    SIGNATURE OF EMPLOYEE AND ID NUMBER

    OFFICE NUMBER

    DATE

    DL 142 (REV 8/93) WWW

    CUT ON LINE AND KEEP THIS PART FOR YOUR RECORDS

    142

    REQUEST FOR CANCELLATION OR


    SURRENDER OF A DRIVER LICENSE OR
    IDENTIFICATION CARD

    A Public Service Agency

    DMV USE ONLY


    Doubled From___________________
    To ___________________

    NAME OF PERSON AS SHOWN ON THE LICENSE OR IDENTIFICATION CARD TO BE CANCELLED

    Information about the


    document being
    cancelled or
    surrendered

    ADDRESS

    CITY

    STATE

    LICENSE OR ID CARD NUMBER TO BE CANCELLED DATE OF BIRTH

    LOCATION OF LICENSE

    Lost/destroyed

    Attached

    ZIP CODE

    Other (explain on reverse)

    Voluntary surrender or I voluntarily surrender and request the cancellation of my:


    Driver License (DL) or
    Identification Card (ID)
    cancellation of a
    Reason for the cancellation or surrender: ________________________________________________
    DL or ID Card
    Is the license in the minors possession? ....................
    Is there a change in the custody of the minor? ............

    Yes
    Yes

    No
    No

    Person cancelling minor


    childs application or I certify under penalty of perjury under the laws of the state of California that:
    (check one)
    I signed the minors application for a license.
    driver license

    I did not sign the application but I gave written consent to the issuance of the minors license.
    I did not sign the application but now have custody of the minor.

    PRINT YOUR NAME

    Signature of person
    completing the form

    SIGNATURE

    ADDRESS

    DMV Employee

    SIGNATURE OF EMPLOYEE AND ID NUMBER

    OFFICE NUMBER

    DL 142 (REV 8/93) WWW

    Print

    Clear Form

    DATE

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