Mail application and all requirements to: DMV, 1905 LANA AVE NE, SALEM OR 97314-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1 by entering your Driver License/Customer Number, Date of Birth, Full Legal Name, Contact Phone Number, and Residence Address. Ensure that the address is an Oregon residence as it will be used for updating your driver record.
3. If applicable, indicate whether you need a replacement driver license by selecting 'YES' or 'NO'. Fill in your mailing address if it differs from your residence address.
4. Proceed to Section 2. Provide details about your employer or self-employment status. Include worksite address and check the days you work. If you drive for work, ensure to submit employment verification.
5. In Section 3, outline any alcohol/drug treatment meetings you attend. Specify meeting times and locations as needed.
6. Complete Section 4 by signing the application to certify that all information provided is accurate. Remember to include the date of signature.

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