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Download Nevada Dmv 128 Template

The Nevada DMV 128 form is a declaration for individuals experiencing homelessness, allowing them to request a waiver of fees for a duplicate driver’s license, instruction permit, or identification card. By completing this form, applicants can certify their homeless status and access essential identification without the financial burden of fees. For assistance in filling out the form, click the button below.

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Article Guide

Nevada Dmv 128 Example

Reno/Sparks/Carson City (775) 684-4DMV (4368)

Las Vegas Area (702) 486-4DMV (4368)

Fax: (775) 684-4992

Website: dmvnv.com

DECLARATION OF HOMELESS STATUS

This form must be submitted along with a DMV-002 (Application for Driving Privileges or ID Card).

LAST NAME (Please Print)

FIRST NAME

MIDDLE NAME

SUFFIX

ADDRESS WHERE I AM STAYING

CITY

STATE

ZIP

	25 AND OLDER	UNDER 25
	NRS 483.417 and NRS 483.825	483.410 and 483.820
	I am requesting a duplicate:	I am requesting an/a:
	 Non-Commercial Driver’s License	 Original  Duplicate  Renewal
	 Instruction Permit	(Choose one)
	 Identification Card	(Choose one)
	 Identification Card	 Non-Commercial Driver’s License
	Fees will be waived one time only and you must	 Non-Commercial Driver’s License
	Fees will be waived one time only and you must	 Driver Authorization Card
	reimburse the Department the cost of the photo fee	 Instruction Permit
	when you renew your card, if employed at that time.	 Instruction Permit
	when you renew your card, if employed at that time.	 Identification Card
		 Identification Card
		All fees for this issuance will be waived one time
		only and are not required to be reimbursed at any
		time.

I hereby certify under penalty of perjury that all statements in this application are true and correct. I agree and understand that any misstatement of material facts may cause cancellation and/or denial of my driver’s license, instruction permit or identification card under NRS 483.420 and 483.530. I further understand that any misstatement of facts may be a misdemeanor or felony under NRS 483.530 and may be punishable pursuant to NRS 193.130.

SIGNATURE OF APPLICANT

DATE

Signatures must be originals. Photocopies are not acceptable.

Changes may not be made to this form once it is signed.

DMV-128 (Revised 12/2019)

Click for Nevada Dmv 128

Guide to Writing Nevada Dmv 128

Filling out the Nevada DMV 128 form is a straightforward process. This form is essential for individuals seeking a waiver of fees for a duplicate driver’s license, instruction permit, or identification card due to homelessness. After completing the form, it will need to be submitted to the DMV for processing.

Obtain the Nevada DMV 128 form from the DMV website or a local DMV office.
At the top of the form, indicate your request by checking the appropriate box for a duplicate Driver’s License, Identification Card, or Instruction Permit.
In the “Applicant’s Printed Name” section, write your full name clearly.
If you know it, fill in your Driver’s License or Identification Card number in the designated space.
Provide your Social Security Number in the next section.
Fill in your Date of Birth accurately.
In the “Address where I am staying” section, write the address where you are currently residing.
Complete the “City,” “State,” and “Zip” fields with the relevant information.
If you are a male aged 18 to 26, decide whether you want to register with the Selective Service. Mark "Yes" or "No" accordingly.
If you answered "Yes," initial the line provided to confirm your registration intention.
Read the certification statement carefully, ensuring that all your information is true and correct.
Sign your name in the “Signature of Applicant” section.
Write the date of your signature in the designated space.
Leave the “DMV Representative” section blank for the DMV staff to complete.

Understanding Nevada Dmv 128

What is the Nevada DMV 128 form?

The Nevada DMV 128 form is a declaration of homeless status that allows individuals experiencing homelessness to request a waiver of fees for a duplicate driver's license, instruction permit, or identification card. This form is designed to assist those who may not have the financial means to pay the standard fees associated with these documents.

Who is eligible to use the DMV 128 form?

Individuals who are homeless and require a duplicate driver's license, instruction permit, or identification card may use this form. To qualify, applicants must certify their homeless status and understand that the fee waiver applies only once. Additionally, if they are employed at the time of renewal, they must reimburse the Department for the photo fee.

What information is required on the DMV 128 form?

Applicants must provide their printed name, driver's license or identification card number (if known), social security number, date of birth, and the address where they are currently staying. The form also includes a section for males aged 18 to 26 to indicate whether they wish to register with the Selective Service.

How often can I use the fee waiver provided by the DMV 128 form?

The fee waiver can be used only once. Applicants should be aware that if they are employed at the time of renewing their card, they will need to reimburse the Department for the photo fee associated with the duplicate document.

What happens if I provide false information on the DMV 128 form?

Providing false information on the DMV 128 form can lead to serious consequences. Misstatements may result in the cancellation or denial of the driver's license, instruction permit, or identification card. Additionally, such misstatements can be classified as a misdemeanor or felony under Nevada law, which may lead to further legal repercussions.

Where can I submit the DMV 128 form?

The completed DMV 128 form can be submitted at any Nevada DMV office. For individuals in rural areas, it is advisable to contact the DMV office for specific submission instructions. The form can also be faxed to the appropriate DMV office if necessary.

What should I do if I have questions about the DMV 128 form?

If you have questions regarding the DMV 128 form, you can contact the DMV Field Services Division. For the Reno/Sparks/Carson City area, call (775) 684-4DMV (4368). For the Las Vegas area, the number is (702) 486-4DMV (4368), and for rural Nevada, you can reach out at (877) 368-7828.

Can I use the DMV 128 form for other DMV services?

No, the DMV 128 form is specifically intended for individuals seeking a fee waiver for a duplicate driver's license, instruction permit, or identification card due to homelessness. It cannot be used for other DMV services or transactions.

What should I do if I lose my DMV 128 form after submission?

If you lose your DMV 128 form after submission, it is advisable to contact the DMV office where you submitted the form. They can provide guidance on the next steps and help you determine whether your request has been processed.

Is there a deadline for submitting the DMV 128 form?

There is no specific deadline for submitting the DMV 128 form; however, it is recommended to submit it as soon as possible if you are in need of a duplicate driver's license, instruction permit, or identification card. Delaying the submission may affect your ability to obtain these documents in a timely manner.

Common mistakes

Incomplete Information: Many applicants fail to fill out all required fields. Missing information, such as the driver's license number or social security number, can lead to delays or rejections.
Incorrect Address: Providing an incorrect address can cause issues. It's essential to ensure that the address where you are staying is accurate and formatted correctly.
Failure to Sign: Some applicants forget to sign the form. Without a signature, the application is considered incomplete and cannot be processed.
Misunderstanding the Homeless Status Declaration: Applicants may not fully understand the declaration of homeless status. Misrepresenting this status can lead to serious legal consequences.
Not Initialing for Selective Service Registration: Males aged 18 to 26 must indicate if they wish to register for the Selective Service. Failing to initial this section may affect eligibility for certain federal benefits.

Document Data

Fact Name	Fact Description
Form Purpose	The DMV 128 form allows individuals to declare their homeless status to request a waiver of fees for a duplicate driver’s license, instruction permit, or identification card.
Governing Law	This form is governed by Nevada Revised Statutes Chapter 483.
Fee Waiver	Individuals can have the fees waived one time only when applying for a duplicate document.
Reimbursement Requirement	If employed at the time of renewal, the individual must reimburse the DMV for the photo fee.
Age Requirement	Men aged 18 to 26 are prompted to register with the Selective Service on this form.
Penalties for Misstatement	Providing false information may lead to cancellation or denial of the application under NRS 483.420 and 483.530.
Criminal Charges	Misstatements can result in misdemeanor or felony charges under NRS 483.530, punishable under NRS 193.130.
Contact Information	The form provides contact numbers for DMV offices in Reno/Sparks/Carson City and Las Vegas.
Effective Date	The current version of the DMV 128 form became effective on July 1, 2010.
Applicant's Certification	The applicant must certify that all statements are true and correct under penalty of perjury.

Documents used along the form

When navigating the process of obtaining a duplicate driver’s license or identification card in Nevada, several forms and documents may be required alongside the DMV 128 form. Each of these documents plays a crucial role in ensuring that your application is complete and that you meet all necessary requirements. Below is a list of commonly used forms and documents that can assist you in this process.

DMV 301 Form: This form is used to apply for a new driver’s license or ID card. It provides personal information and serves as the primary application document.
Ohio Living Will Form: To ensure your medical treatment preferences are honored, utilize the essential Living Will guidelines for Ohio to accurately document your wishes.
DMV 002 Form: Known as the "Application for Driver’s License or Identification Card," this form is essential for first-time applicants and individuals who need to update their information.
Proof of Identity Documents: Acceptable documents include a birth certificate, passport, or military ID. These are necessary to verify your identity when applying for a duplicate license.
Social Security Card: A copy of your Social Security card may be required to confirm your social security number, which is an important part of the application process.
Proof of Residency: Documents such as utility bills or bank statements can serve as proof of your current address. This is particularly important for homeless individuals applying for the waiver.
Selective Service Registration: For males aged 18 to 25, proof of registration with the Selective Service may be necessary to complete the application process.
DMV 120 Form: This form is used for reporting a lost or stolen driver’s license. If your original license is missing, this document helps ensure that your application for a duplicate is processed smoothly.

Gathering these documents in advance can streamline your experience at the DMV and help you avoid delays. Each form serves a specific purpose, and understanding their roles can make the application process more manageable. Always double-check the requirements on the Nevada DMV website or contact their office directly for the most current information.

Similar forms

Form MV-1 (Application for Title): This form is used in Nevada to apply for a vehicle title. Like the DMV 128, it requires personal information and certifies the applicant's eligibility for certain benefits. Both forms aim to simplify processes for individuals needing official documentation.
Form DMV-2 (Application for Duplicate License): Similar to the DMV 128, this document is specifically for individuals seeking a replacement for their lost or stolen driver’s license. Both forms involve declarations and require the applicant to provide personal details and affirm their identity.
Emotional Support Animal Letter: To enhance mental well-being, consider obtaining an Emotional Support Animal Letter form from a licensed mental health professional, which can provide essential support and access for those with emotional challenges.
Form DMV-3 (Application for Identification Card): This form serves those who need a state-issued identification card. Like the DMV 128, it includes sections for personal information and a declaration of eligibility, ensuring that applicants can receive the necessary identification without undue barriers.
Form DMV-4 (Application for Instruction Permit): This document is for individuals applying for a learner's permit. Similar to the DMV 128, it requires the applicant to provide personal information and confirm their qualifications, facilitating access to driving privileges for eligible individuals.