BMV FORM NO. (2019-03) – REV. Jun. 11-2019
BMV FORM NO. (2019-03) – REV. Jun. 11-2019 GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES OFFICE OF THE GOVERNOR BUREAU OF MOTOR VEHICLES DISABLED PERSON IDENTIFICATION CARD APPLICATION FORM APPLICANT INFORMATION Name: Date of Birth: SSN: Phone: Current address: City: State: ZIP Code: Gender: Weight: Eye Color: Hair Color: Height: Blood Type: Place of Birth: Phone #: Organ Donor Glasses: Yes No MAILING ADDRESS (IF DIFFERENT) Mailing Address: Allergies: Email Address: PLEASE CHECK ALL THAT APPLY PHYSICAL MENTAL VISUAL DEVELOPMENTAL HEARING WARNING UNDER TITLE 20, SECTION 548 VIC, IT IIS IN VIOLATION “TO USE FALSE OR FICTITIOUS NAMES ON ANY APPLICATION FOR A DRIVER’S LICENSE OR IDENTIFICATION CARD, OR KNOWINGLY TO MAKE FALSE STATEMENT, KNOWNINGLY TO CONCEAL A MATERIAL FACT OR OTHERWISE COMMIT A FRAUD IN ANY SUCH APPLICATION.” MINOR CONSENT TO TITLE 20, SECTION 374, SUB-DIVISION OF THE VIRGIN ISLANDS CODE, BEING THE PARENT, GUARDIAN OR OTHER PERSON RESPONSIBLE FOR THE CARE, CUSTODY OR CONTROL OF A MINOR (UNDER THE AGEOF 18), I HEREBY GIVE MY CONSENT TO THE U.S. …
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BMV FORM NO. (2019-03) – REV. Jun. 11-2019 GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES OFFICE OF THE GOVERNOR BUREAU OF MOTOR VEHICLES DISABLED PERSON IDENTIFICATION CARD APPLICATION FORM APPLICANT INFORMATION Name: Date of Birth: SSN: Phone: Current address: City: State: ZIP Code: Gender: Weight: Eye Color: Hair Color: Height: Blood Type: Place of Birth: Phone #: Organ Donor Glasses: Yes No MAILING ADDRESS (IF DIFFERENT) Mailing Address: Allergies: Email Address: PLEASE CHECK ALL THAT APPLY PHYSICAL MENTAL VISUAL DEVELOPMENTAL HEARING WARNING UNDER TITLE 20, SECTION 548 VIC, IT IIS IN VIOLATION “TO USE FALSE OR FICTITIOUS NAMES ON ANY APPLICATION FOR A DRIVER’S LICENSE OR IDENTIFICATION CARD, OR KNOWINGLY TO MAKE FALSE STATEMENT, KNOWNINGLY TO CONCEAL A MATERIAL FACT OR OTHERWISE COMMIT A FRAUD IN ANY SUCH APPLICATION.” MINOR CONSENT TO TITLE 20, SECTION 374, SUB-DIVISION OF THE VIRGIN ISLANDS CODE, BEING THE PARENT, GUARDIAN OR OTHER PERSON RESPONSIBLE FOR THE CARE, CUSTODY OR CONTROL OF A MINOR (UNDER THE AGEOF 18), I HEREBY GIVE MY CONSENT TO THE U.S. VIRGIN ISLANDS BUREAU OF MOTOR VEHICLES FOR THE ISSUANCE TO THE SAID MINOR OF AN IDENTIFICATION CARD. Signature of Parent/ Guardian: __________________________________________ Date: _______________________________ Signature of Applicant: Date: License or Identification pictures are not taken with exposed shoulders or spaghetti strapped clothing. For more information, please call the St. Thomas BMV at (340) 774-4268, the St. Croix BMV at (340) 713- 4268 or the St. John BMV at (340) 776-6262 SIGN SIGN BMV FORM NO. (2019-03) – REV. Jun. 11-2019 GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES OFFICE OF THE GOVERNOR BUREAU OF MOTOR VEHICLES DISABLED PERSON IDENTIFICATION CARD APPLICATION FORM In order to obtain a Disabled Person’s ID (Initial, duplicate or renewal) The following original documents are required: No Pictures (photographs) are taken at the Bureau of Motor Vehicles with head coverings. Applicant must provide a written request on official letterhead from their religious institution to the Bureau of Motor Vehicles in order for this exception to be considered and/or granted. Identification pictures are not taken with exposed shoulders or spaghetti strapped clothing. 1 2 Identification Bring one (1): o Certified U.S. birth certificate o Valid, unexpired, U.S. passport o Certificate of naturalization o Certificate of Citizenship o Consular proof of birth abroad o Alien registration receipt card (green card, form I-551) o Work Authorization Permit Card Name Change (if applicable) o Original or certified copy of all marriage certificates or court orders that show your name change(s) including Divorce Decrees. (Uncertified photo copies are not valid) Social Security Number (SSN) – (all nine (9) digits must appear on the document) Bring one (1): o Social Security Card o DD 214 o SSA 1099 o NON-SSA 1099 o Stamped IRB Income Tax Return 3 4 Residential Address (NOT post office box) Bring one (1): o Deed, mortgage, payment booklet, or notarized rental agreement o Utility bill or hookup/work order o Home Insurance Statement o Property tax statement o Notarized statement from person you live with along with one address document (see above) in that person’s name Physician’s certification form: o BMV Form 2019-03A completed by a specialized licensed physician in his or her respective field of medical practice who will determine and certify the presence of disabilities stated in BILL NO. 29-0298.