Issuance of Permit is restricted to persons EIGHTEEN YEARS or over who hold a valid U.S.A. or Territorial License. PERMIT VALID FOR ONE YEAR. Not renewable.

 MANDATORY REQUIREMENTS
(1) Attach 2 recent signed Passport Type Photos (2" x 2")
(2) Enclose permit fee of $10.00 (NO CASH)
(3) If mailing application, a photocopy of U.S. Driver's License must accompany completed application.

NOTE: IT IS IMPORTANT THAT YOUR U.S.A. OR TERRITORIAL LICENSE BE CARRIED WITH THE PERMIT AT ALL TIMES. The International or Inter-American Permit is not valid for driving in the United States.

Mr. Mrs. Ms. (Circle One)
FIRST__________________________MIDDLE______________________________LAST_____________________________________________________________

PHONE_________________HOME STREET ADDRESS______________________________________________________________________________

CITY______________________________________________________________STATE______________________________ZIP CODE__________________

U.S. DRIVER'S LICENSE NO.__________________________________________STATE OF ISSUE_____________________

EXPIRATION DATE______________

BIRTHPLACE:
CITY__________________________________________________

STATE OR COUNTRY_____________BIRTH DATE (MO . DAY YEAR)_____________

DATE PERMIT TO BE EFFECTIVE_______________________________________

DEPARTURE DATE FROM U.S.______________________________________

Countries to be visited:______________________________________________________________________________________

PLEASE CHECK THE APPROPRIATE BOX BELOW TO INDICATE THE TYPE OF VEHICLE FOR WHICH YOU NOW HOLD A VALID U.S.A. OR TERRITORIAL DRIVER'S LICENSE, AND FOR WHICH YOU DESIRE THIS PERMIT:

I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT, AND THAT THE LICENSE INDICATED HAS NOT BEEN SUSPENDED NOR REVOKED.
I FURTHER CERTIFY THAT I UNDERSTAND THAT A VALID STATE DRIVER'S LICENSE MUST ACCOMPANY THIS PERMIT, AND THAT THIS PERMIT IS VALID ONLY AS LONG AS THE STATE LICENSE IS VALID, BUT NOT TO EXCEED ONE YEAR FROM THE DATE THE PERMIT IS ISSUED.

SIGNATURE__________________________________________________________DATE_________________________________
(signature mandatory for issuance of Permit)

THIS IS YOUR MAILING LABEL. Please print to ensure prompt delivery

NAME_______________________________________________________________________

STREET_____________________________________________________________________

CITY_________________________________STATE___________ZIP CODE_____________

COUNTRY___________________________________________________________________

Geographical Areas Which Honor International Driving Permits (Convention on Road Traffic, United Nations, Geneva 1949) as of June, 1996

*Not party of 1949 Convention: International Driving Permit Honored.

**U.S. driver's license and International Driving Permit recognized on presentation to local police and payment of Special Registration Fee upon arrival.

***Geographical Areas Which Honor Inter-American Driving Permits (Convention on Regulation of Inter-American Motor Vehicle Traffic, Organization of American States, Washington, D.C. 1943) as of June, 1996. If you intend to drive in the following countries, be sure to check INTER-AMERICAN DRIVING PERMIT box page 1: Brazil and Uruguay.

AMOUNT____________________RECEIPT NO.________________________PERMIT NO.___________________________DATE ISSUED__________________

SENT TO:____________________________________________________________________________________________________________________________