PennDOT - Acknowledgment of Suspension Revocation Disqualification Cancellation 2026

1. Click ‘Get Form’ to open it in the editor.
2. In Section A, enter your PA Driver's License/Permit Number, Date of Birth, Last Name, First Name, Middle Name, Telephone Number, and Email Address if applicable. Ensure all fields are filled out clearly.
3. If you need to change your address, provide the new street address along with the city, state, and zip code. Remember that a P.O. Box can be included but cannot be the only address listed.
4. In Section B, mark the appropriate box regarding your licensing status and provide any additional information requested about your license or permit status.
5. In Section C, print your name clearly and acknowledge your driving privilege status by signing in ink and dating the form.
6. Finally, review all sections for accuracy before submitting the form as instructed in Section D.

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