PA DL-121 2012-2026 free printable template
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DL-121 (12-12) SEIZURE REPORTING FORM PLEASE TYPE OR PRINT IN BLUE OR BLACK INK ALL INFORMATION Bureau of Driver Licensing, P.O. Box 68682, Harrisburg, PA 17106-8682, (717) 787-9662 THIS FORM APPROVED
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How to fill out penndot driving form seizure
How to fill out PA DL-121
01
Obtain the PA DL-121 form from the Pennsylvania Department of Transportation (PennDOT) website or office.
02
Fill in your personal details including your name, address, date of birth, and driver's license number if applicable.
03
Provide any additional information requested regarding your driving history.
04
Sign and date the form to certify that the information provided is accurate.
05
Submit the completed form to the appropriate PennDOT office, either in person or via mail.
Who needs PA DL-121?
01
Individuals who require a duplicate driver's license or identification card in Pennsylvania.
02
People who have lost their driver's license or need to change information on it due to factors like a name change or other personal details.
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People Also Ask about seizure reporting form penndot
How do I contact PennDOT medical Unit?
For more information, please feel free to visit the Medical Reporting Information Center section of our website. PennDOT's Customer Call Center at 717-412-5300. TTY callers — please dial 711 to reach us. The Call Center hours of operation are Monday through Friday, 8 a.m. to 5 p.m.
How long do you have to be seizure free to drive in PA?
§ 83.4(a) states that a person who has a seizure disorder will not be qualified to drive unless a licensed physician reports that the person has been free from seizure for at least 6 months immediately preceding, with or without medication.
How do I get my license back after a seizure in PA?
In Pennsylvania, you must be seizure free for six months before you will be permitted to drive. Your physician will be required to complete a medical report stating that your seizures are controlled and send that report to the Pennsylvania Department of Transportation.
How do I register my DOT medical card in PA?
In Person: At your local PennDOT Driver License Center. PennDOT will mail you a receipt indicating that the Medical Examiner's Certification and/or Self-Certification Form has been processed. You should keep this receipt.
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What is PA DL-121?
PA DL-121 is a form used in Pennsylvania for reporting the application for a duplicate driver's license, learner's permit, or identification card.
Who is required to file PA DL-121?
Individuals who have lost, stolen, or damaged their driver's license, learner's permit, or identification card must file PA DL-121 to request a duplicate.
How to fill out PA DL-121?
To fill out PA DL-121, provide personal information such as name, address, date of birth, and details regarding the lost or damaged document. Follow the instructions on the form carefully.
What is the purpose of PA DL-121?
The purpose of PA DL-121 is to request the issuance of a duplicate driver's license, learner's permit, or identification card in cases of loss, theft, or damage.
What information must be reported on PA DL-121?
The information that must be reported on PA DL-121 includes the applicant's full name, address, date of birth, the type of document being replaced, and any relevant identification numbers.
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