Structure
The Nevada DMV 128 form is a critical document for individuals experiencing homelessness who need to obtain a duplicate driver’s license, instruction permit, or identification card. This form allows applicants to declare their homeless status, which qualifies them for a waiver of fees associated with these documents, as outlined in Nevada Revised Statutes Chapter 483. However, it is important to note that the fee waiver is available only once, and individuals must agree to reimburse the Department for the photo fee upon renewal if they are employed at that time. The form requires personal information, including the applicant's name, driver’s license number, social security number, and date of birth, along with the address where the individual is currently staying. Additionally, there is a section that addresses Selective Service registration for eligible males, emphasizing the importance of maintaining access to federal benefits. The applicant must certify the accuracy of their statements under penalty of perjury, highlighting the seriousness of the information provided. Completing the DMV 128 form accurately is essential for ensuring that individuals receive the necessary identification without incurring fees, thus facilitating their access to services and opportunities.
Nevada Dmv 128 Sample
Reno/Sparks/Carson City (775)
Las Vegas Area (702)
Fax: (775)
Website: dmvnv.com
DECLARATION OF HOMELESS STATUS
This form must be submitted along with a
LAST NAME (Please Print)
FIRST NAME
MIDDLE NAME
SUFFIX
ADDRESS WHERE I AM STAYING
CITY
STATE
ZIP
25 AND OLDER |
UNDER 25 |
|
NRS 483.417 and NRS 483.825 |
483.410 and 483.820 |
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I am requesting a duplicate: |
I am requesting an/a: |
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Original Duplicate Renewal |
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Instruction Permit |
(Choose one) |
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Identification Card |
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Fees will be waived one time only and you must |
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Driver Authorization Card |
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reimburse the Department the cost of the photo fee |
Instruction Permit |
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when you renew your card, if employed at that time. |
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Identification Card |
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All fees for this issuance will be waived one time |
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only and are not required to be reimbursed at any |
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time. |
I hereby certify under penalty of perjury that all statements in this application are true and correct. I agree and understand that any misstatement of material facts may cause cancellation and/or denial of my driver’s license, instruction permit or identification card under NRS 483.420 and 483.530. I further understand that any misstatement of facts may be a misdemeanor or felony under NRS 483.530 and may be punishable pursuant to NRS 193.130.
SIGNATURE OF APPLICANT
DATE
Signatures must be originals. Photocopies are not acceptable.
Changes may not be made to this form once it is signed.
File Attributes
| Fact Name | Description |
|---|---|
| Purpose | The DMV 128 form is used to declare homeless status in order to waive fees for obtaining a duplicate driver’s license, instruction permit, or identification card. |
| Governing Law | This form is governed by Nevada Revised Statutes Chapter 483, which outlines the provisions for waiving fees for homeless individuals. |
| One-Time Waiver | The fee waiver for the duplicate card is granted only once. If the applicant is employed at the time of renewal, they must reimburse the Department for the photo fee. |
| Selective Service Registration | Males aged 18 to 25 are prompted to register for the Selective Service, which is important for eligibility for federal benefits and jobs. |
| Certification | Applicants must certify that all information provided is true and correct, acknowledging that false statements may lead to denial or cancellation of their license. |
| Contact Information | The form provides contact details for the DMV, including phone numbers for different regions in Nevada and a website for further assistance. |
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