HomeMy WebLinkAboutDeclaration of Lost Real ID Compliant CredentialVEHICLE REGISTRATION & LICENSING DIVISION
DRIVER LICENSE SECTION
DECLARATION OF LOST REAL ID CREDENTIAL
Driver License No: ______________________________ Date of Birth: ______________________
State Identification No: __________________________
Name: __________________________________________________________________________
LAST FIRST MIDDLE
Address: ________________________________________________________________________
______ I no longer have my State Identification Card issued by the State of Hawai’i or State of _________________________ on __________________________ as my REAL ID Compliant
Credential, in my possession. I further understand that Federal and State law allows a person to have only one (1) REAL ID compliant credential. No refunds.
______ I no longer have or did not receive my Hawai’i State Driver’s Instructional Permit or Driver‘s License issued on __________________________ in my possession as my REAL ID compliant
credential. I further understand that Federal and State law allows a person to have only one (1) REAL ID compliant credential. No refunds.
______ I no longer have my out of state Instructional Permit or Driver’s License issued on _____________________ from the State of ______________________. Permit or License #______________________
___. I further understand that Federal and Hawai’i State law allows a person to have only one (1) REAL ID compliant credential. No refunds.
I, the undersigned, do hereby state that I am the applicant described on the driver’s license or state identification application form. I understand that pursuant to Chapter 286, Hawai’i
Revised Statutes, I may be prosecuted for any intentional misinformation provided on this form. I further understand that all fees paid with an application found to contain misinformation
shall be forfeited to the County of Hawai'i.
ANY REAL ID CREDENTIAL ISSUED BY THE STATE OF HAWAII, ANY OTHER JURISDICTION OR AGENCY, MUST BE TURNED IN TO THE NEAREST DRIVER’S LICENSE/STATE ID OFFICE IF RECEIVED IN THE MAIL OR
FOUND AFTER THIS FORM IS SIGNED. FAILURE TO DO SO MAY RESULT IN CRIMINAL CHARGES AND MAY BE PROSECUTED TO THE FULL EXTENT OF THE LAW.
APPLICANT’S SIGNATURE: __________________________________________Date: ________________