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A Public Service Agency
DL 937 (REV. 4/2009) UH
VERIFICATION FOR REDUCED FEE IDENTIFICATION CARD
Please complete this form in its entirety and give to the applicant for further processing. This form must be
presented to the Department of Motor Vehicles (DMV) within 60 days of its completion by the governmental
Applicant Information (Please Print):
_________________________________________________________________________ ________________________________
LAST NAME FIRST MIDDLE DATE OF BIRTH (MM/DD/YYYY)
_________________________________________________________________________ ________________________________
ADDRESS CITY STATE ZIP CODE CA DRIVER LICENSE / IDENTIFICATION CARD NUMBER
The individual (applicant) named above meets the eligibility requirements for assistance programs under
Chapter 2 or Chapter 3 of Part 3 of, or Part 5 of, or Article 9 of Chapter 10 of Part 6 of, or Chapter 10.1 or Chapter
§ 14902(c).
____________________________________________________________________________________________________________
PRINTED NAME OF REPRESENTATIVE FOR ENTITY
____________________________________________________________________________________________________________
ENTITY NAME
____________________________________________________________________________________________________________
ADDRESS CITY STATE ZIP CODE TELEPHONE NUMBER
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is
____________________________________________________________________ ____________________
SIGNATURE OF REPRESENTATIVE FOR ENTITY DATE
the California Driver Handbook or online at www.dmv.ca.gov. This form must be presented to DMV within 60
Save time, make an appointment online at www.dmv.ca.gov
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