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Blank Nevada Dmv 128 Template

The Nevada DMV 128 form is a "Declaration of Homeless Status" used to certify an individual's status as homeless, allowing for the waiver of fees for obtaining a duplicate driver's license, instruction permit, or identification card, as outlined in Nevada Revised Statutes Chapter 483. This certification allows qualified individuals to bypass certain costs, though it specifies that the waiver is a one-time benefit and employment at the time of renewal necessitates reimbursing the Department for the photo fee. Highlighting the importance of accurate reporting, the form requires applicants to certify the truthfulness of their provided information under penalty of perjury, emphasizing the legal obligations and potential consequences for misstatements.

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Empathy and practicality intersect with the legal world in the Nevada DMV 128 form, a vital yet perhaps not widely familiar document crucial for those facing homelessness. At its core, the Declaration of Homeless Status form serves a compassionate function, allowing Nevada residents who are homeless to request a waiver for fees tied to obtaining a duplicate driver's license, instruction permit, or identification card. Recognizing the heightened barriers faced by individuals without stable housing, Nevada Revised Statutes Chapter 483 underpins this initiative, providing a one-time fee waiver to support those in need. However, it carries the stipulation that recipients reimburse the photo fee upon employment and card renewal. Besides basic personal information, the form also inquires about an applicant's potential interest in registering with the Selective Service, which remains a prerequisite for various federal benefits, including student loans and job training, highlighting a broader impact on an applicant's future opportunities. Completeness and honesty in filling out the form are imperative, as any misstatement could lead to misdemeanor or felony charges alongside potential denial or cancellation of the requested document, underlining the balance between aid and accountability embedded within the DMV 128 form process.

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

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.

 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)

File Features

Fact Name Detail
Purpose of the Form The Nevada DMV 128 form is used by individuals to declare homeless status in order to waive fees for obtaining a duplicate driver’s license, instruction permit, or identification card.
Governing Law The form is governed by Nevada Revised Statutes Chapter 483, specifically focusing on the waiver of fees for homeless individuals.
One-time Waiver It allows for the fees to be waived one time only, with the requirement that the individual must reimburse the Department for the photo fee upon card renewal if employed at the time.
Selective Service Registration Male applicants between 18 and 26 years old are given the option to register with the Selective Service through this form, which is necessary for federal student loans, grants, job training benefits, federal employment, and citizenship eligibility.
Penalty for False Statements Applicants are warned that any misstatement of material facts may lead to cancellation or denial of the application under NRS 483.420 and 483.530. Further, misstatements may constitute a misdemeanor or felony under NRS 483.530, punishable according to NRS 193.130.
Contact Information It lists multiple contact options, including phone numbers for the Field Services Division in Reno/Sparks/Carson City, the Las Vegas Area, and Rural Nevada, as well as a fax number and a website address.
Effective Date The current form revision took effect on July 1, 2010, as indicated at the bottom of the form.

Nevada Dmv 128 - Usage Guidelines

When individuals find themselves without a fixed, regular, and adequate nighttime residence, the state of Nevada provides a mechanism to waive certain fees associated with obtaining a duplicate driver's license, instruction permit, or identification card. This act of support is facilitated through the DMV 128 form titled "Declaration of Homeless Status," which, as the name suggests, is a declaration used by individuals experiencing homelessness to have their fees waived for the aforementioned services. The process of completing this form is straightforward yet requires attention to detail to ensure all the information provided is accurate and truthful. Follow these steps closely to fill out the form correctly.

  1. Begin by locating the section headed "DECLARATION OF HOME HOMELESS STATUS" on the form.
  2. Read the preamble carefully to understand the conditions under which you qualify for the fee waiver.
  3. In the section provided, indicate which document you are requesting—the duplicate Driver’s License, Identification Card, or Instruction Permit. Mark the appropriate box.
  4. Proceed to fill in your printed name in the space labeled "Applicant’s Printed Name."
  5. Enter your Driver’s License/Identification Card Number in the designated space, if known. If not, leave blank.
  6. Provide your Social Security Number in the corresponding field.
  7. Fill in your Date of Birth in the space provided.
  8. Next, enter the address where you are currently staying, including the City, State, and Zip code. If you do not have a fixed address, provide a general location where you can be contacted.
  9. If you are a male between the ages of 18 and less than 26, decide whether you would like to register with the Selective Service. Check "Yes" or "No" accordingly and initial if you choose "Yes."
  10. Read the certification statement carefully, understanding that any misrepresentation can have serious consequences under Nevada law.
  11. Sign the form in the space labeled "Signature of Applicant," and date it accordingly.
  12. The final section is for the DMV Representative to complete; leave this blank.

Once the form is fully completed, it is imperative to review each section to ensure all information is accurate and truthful. After verification, the form should be submitted to the designated DMV office either in person or via the fax number provided. This submission will initiate the process of obtaining a duplicate document without the associated fees, provided the applicant meets the stated criteria. It's important to remember that this waiver can be utilized once, and future renewals or duplicates will require standard fees unless the individual remains unemployed at the time of renewal. The accuracy and honesty in completing this form cannot be overstated, as it not only affects the immediate ability to obtain needed documentation but also aligns with legal obligations under state law.

Important Details about Nevada Dmv 128

  1. What is the purpose of the Nevada DMV 128 form?

    The Nevada DMV 128 form is used to declare a person's homeless status to qualify for a waiver of fees associated with obtaining a duplicate driver’s license, instruction permit, or identification card as prescribed in Nevada Revised Statutes Chapter 483. This waiver is granted on a one-time only basis, and individuals may need to reimburse the Department for the cost of the photo fee upon renewal of their card if they are employed at that time.

  2. Who is eligible to use the Nevada DMV 128 form?

    Individuals who are homeless and thus unable to provide a fixed residential address are eligible to use the Nevada DMV 128 form to request a one-time waiver for the fees associated with obtaining a duplicate driver's license, instruction permit, or identification card.

  3. What are the requirements for filing the Nevada DMV 128 form?

    To file the Nevada DMV 128 form, the applicant must certify their homeless status, provide their printed name, any known driver’s license/identification card number, social security number, date of birth, and the address where they are currently staying. Males between 18 and 26 must decide if they want to register with the Selective Service. The applicant must also sign the form, certifying under penalty of perjury that all statements made are true and correct.

  4. Is there a fee associated with the Nevada DMV 128 form?

    No, the primary purpose of the Nevada DMV 128 form is to request a waiver for the fees usually required for a duplicate driver's license, instruction permit, or identification card for homeless individuals. However, those qualifying for the waiver must agree to reimburse the Department for the photo fee when they renew their document, provided they are employed at that time.

  5. How often can the Nevada DMV 128 form be used?

    The waiver of fees associated with the Nevada DMV 128 form can be utilized once. It is a one-time only waiver intended to assist individuals who are experiencing homelessness.

  6. What happens if false information is provided on the Nevada DMV 128 form?

    Providing false information on the Nevada DMV 128 form is a serious offense. It may cause cancellation and/or denial of the applicant's driver's license, instruction permit, or identification card under NRS 483.420 and 483.530. Additionally, misstatement of facts may be considered a misdemeanor or felony under NRS 483.530 and may be punishable pursuant to NRS 193.130.

  7. Can I register for the Selective Service using the Nevada DMV 128 form?

    Yes, male applicants who are at least 18 and less than 26 years of age have the option to register for the Selective Service when filling out the Nevada DMV 128 form. Registration is important for remaining eligible for federal student loans, grants, job training benefits, most federal jobs, and, if applicable, citizenship in the United States.

  8. Where can I submit the completed Nevada DMV 128 form?

    The completed Nevada DMV 128 form can be submitted to any DMV office within Nevada. Contact information, including phone numbers and the fax number, is provided at the top of the form for individuals who may have questions or need further assistance.

  9. Can someone else fill out and submit the Nevada DMV 128 form on behalf of the applicant?

    The form requires the signature of the applicant, certifying under penalty of perjury that all statements made in the application are true and correct. Therefore, while someone else may assist in filling out the information, the applicant must review and sign the form themselves.

  10. Is there an expiration date on the Nevada DMV 128 form?

    The form indicates a revision date of July 2010 (Rev. 7/2010), but there is no specific expiration date mentioned. It's advisable to check with the Nevada DMV or its website for the most current version of the form or any updates on its validity before submission.

Common mistakes

When filling out the Nevada DMV 128 form, specifically designed for individuals declaring homeless status to waive certain fees, there are several common mistakes to avoid. This document is crucial for those in need, as it assists in obtaining a duplicate driver's license, instruction permit, or identification card without the associated costs. Being mindful of these common errors can streamline the process, ensuring that the application proceeds without unnecessary delays or rejections.

  1. Not thoroughly reviewing the form before submission is a frequent oversight. This can lead to incomplete sections, which might delay the processing of the application.

  2. Incorrectly filling in the driver's license or identification card number, if known, compromises the identification process, potentially leading to delays or even rejection of the application.

  3. An incomplete or incorrect Social Security Number (SSN) can significantly delay the process. The SSN is a critical identifier that must be accurately provided.

  4. Failing to provide a precise date of birth can create confusion and slow down the application's progress.

  5. Some applicants forget to indicate their current residing address or provide an incomplete address. While declaring homeless status, it's important to mention a temporary or usual place of stay if available.

  6. Not responding to the Selective Service question correctly can affect eligibility for certain federal benefits. Male applicants between 18 and 26 years old must pay special attention to this section.

  7. Omitting initials next to the Selective Service question, if choosing to register, neglects to confirm the applicant's intent clearly, which is necessary for processing.

  8. Signing the form without carefully reading the certification statement may lead to inadvertent misrepresentations. Understanding the legal implications of the information provided is crucial.

  9. Submitting the form without the signature of the DMV representative can invalidate the application. This signature confirms the department's acknowledgment and processing of the form.

  10. Ignoring the instructions for reimbursement of the photo fee upon employment and renewal of the card may lead to future confusion or complications. Awareness of this responsibility is important for financial planning.

These mistakes, though seemingly small, can have significant implications on the success of an application. Applicants must remember that accuracy, thoroughness, and honesty are paramount when completing the Nevada DMV 128 form. Acknowledging these common errors can aid individuals in navigating the process more effectively, helping to ensure that those in need receive the support and documentation necessary for their personal and professional lives.

Lastly, it's important to visit www.dmvnv.com or contact the appropriate DMV office for any questions or clarification needed when filling out the form. Being proactive in seeking assistance or verifying information can be instrumental in avoiding mistakes and ensuring the application is processed efficiently and effectively.

Documents used along the form

When navigating through the process of verifying your homeless status in Nevada, particularly with the utilization of the DMV 128 form for a waiver of fees for a duplicate driver’s license, instruction permit, or identification card, there are other documents and forms that often play a crucial role. Understanding these documents can streamline the process and ensure you have all necessary materials prepared.

  • Proof of Identity Document: This can include a birth certificate, passport, or any government-issued identification that verifies your name and date of birth. These documents are essential for the initial identification process.
  • Proof of Social Security Number (SSN): A Social Security card or an official document with your name and SSN, like a W-2 form, is required. This helps in verifying your SSN for the record.
  • Proof of Nevada Residency: Even if you are homeless, any document that can establish a connection to a local shelter or a homeless service provider in Nevada can serve as proof of residency. Letters from shelters or service providers often fulfill this requirement.
  • Application for Driving Privileges or ID Card (DMV 002): This form is needed when applying for a new, renewal, or duplicate Nevada driver's license or ID, in conjunction with the DMV 128 form for individuals experiencing homelessness.
  • Medical Evaluation Form (DLD 136): If applicable, this form evaluates your fitness to drive, required in specific cases determined by DMV staff or if you are applying for certain endorsements on your license.
  • Change of Address Form (DMV 22): While being homeless might mean you do not have a permanent address, any temporary mailing address or changes thereof need to be reported to the DMV, ensuring you receive any correspondences or documents.

Together, these documents support the application and verification process associated with the Nevada DMV 128 form. Each plays a role in demonstrating eligibility for fee waivers and maintaining accurate and up-to-date information with the Nevada DMV. Ensure you have the correct and most recent versions of these forms and documents by checking with the Nevada DMV or their website.

Similar forms

The Nevada DMV 128 form is similar to other documents that also serve to affirm personal circumstances or qualifications, without requiring extensive evidence at the point of application, but rather trust and penalties for misinformation. Each document, while unique in its requirements and implications, shares a common underlying principle of self-attestation to facilitate certain administrative or legal processes.

The California Department of Motor Vehicles (DMV) Request for Fee Waiver Form is a document with a similar purpose as the Nevada DMV 128 form. Like the Nevada form, it allows individuals facing financial hardship to apply for a reduction or waiver of standard DMV fees. The key similarity lies in the self-certification element, where applicants must attest to their financial status without initially providing extensive documentation, under penalty of perjury. This form is utilized to ensure that essential services, such as obtaining a driver's license or state identification, remain accessible to all residents, regardless of their economic situation.

The Affidavit of Indigency Form, often used in various states' court systems, is another document that resembles the Nevada DMV 128 form in its purpose and structure. This form is designed for individuals who cannot afford legal representation or court fees, allowing them to request a waiver or reduction of those fees based on their financial status. The similarity revolves around the requirement for applicants to declare their economic hardship and qualify for assistance through self-attestation, with legal consequences for false statements. It underscores the balance between making access to legal and governmental services available to all, and the need to prevent abuse of these processes through stringent penalties for false declarations.

The Application for Fee Waiver in Federal Courts is an additional document echoing the principles found in the Nevada DMV 128 form. Federal courts require this form from individuals seeking to have their court fees waived due to financial hardship. The form necessitates a detailed self-declaration of one’s financial situation, much like the Nevada DMV 128 form requires a declaration of homelessness status. The critical similarity lies in the reliance on the honesty of the applicant, supported by the deterrent of legal penalties for misinformation, to facilitate access to necessary legal proceedings for those who might otherwise be financially excluded.

Dos and Don'ts

When filling out the Nevada DMV 128 form, which is a Declaration of Homeless Status for the waiver of fees associated with obtaining a duplicate driver’s license, instruction permit, or identification card, it's important to follow some specific dos and don'ts to ensure your application is completed correctly and efficiently.

Do:

  • Read the form thoroughly before you start filling it out. Understanding what is requested will help you avoid mistakes.
  • Ensure all the information is accurate, especially your name, social security number, date of birth, and any identification number if known.
  • Sign and date the form in the designated areas to confirm the authenticity of the information provided.
  • If applicable, indicate your willingness to register with the Selective Service by choosing 'Yes' and initialing the form.
  • Check for clarity in your handwriting to ensure that every detail can be easily read.

Don't:

  • Leave any required fields blank. If a question does not apply to you, consider writing 'N/A' (for Not Applicable) instead of leaving it empty.
  • Forget to provide the address where you are staying, even if it is not a permanent address.
  • Avoid the temptation to provide false information. Misstatements can be considered misdemeanors or felonies and could result in the denial or cancellation of your document.
  • Rush through the form without double-checking your entries for mistakes or omissions.
  • Fail to update your information with the DMV should your situation change, especially your address or employment status.

By following these guidelines, you can ensure a smoother process in obtaining your duplicate document while respecting the legal requirements of the Nevada Department of Motor Vehicles.

Misconceptions

When it comes to navigating Nevada's Department of Motor Vehicles (DMV) forms, confusion often arises, especially regarding the DMV 128 form, which is a Declaration of Homeless Status. It's important to clear up some common misconceptions to ensure that individuals who need this service can access it efficiently.

  • Misconception 1: The DMV 128 form is for renewing your driver's license or ID.

    This is incorrect. The DMV 128 form is specifically to certify an individual as homeless and to qualify them for a waiver of fees for a duplicate driver’s license, instruction permit, or identification card. It is not a form used for the regular renewal of these documents.

  • Misconception 2: You need a permanent address to fill out the DMV 128 form.

    Contrary to what some might think, this form allows individuals without a fixed, permanent address to declare their homelessness and still obtain necessary identification documents. The form provides a space to list an address where the individual is staying, acknowledging that a traditional home address might not be available.

  • Misconception 3: Anyone can use the DMV 128 form multiple times for free duplicates.

    This belief is not accurate. While the DMV 128 form exists to help those in need by waiving certain fees, it specifies that the fee waiver for obtaining a duplicate license, permit, or ID card is a one-time courtesy. Should the individual require another duplicate while still meeting the form’s criteria, the waived fees from the original document must be reimbursed if they are employed.

  • Misconception 4: Selective Service registration is optional for eligible males who use the form.

    This misunderstanding could lead to eligibility issues for federal programs. The form clearly mentions that males between 18 and 25 must decide whether to register with the Selective Service to remain eligible for federal loans, grants, job training, most federal jobs, and, if applicable, U.S. citizenship. This choice is significant and not merely optional.

Correctly understanding the DMV 128 form ensures that individuals in a vulnerable position can access vital services without unnecessary barriers. Clarifying these misconceptions promotes a smoother process for those seeking assistance through Nevada's DMV, especially in overcoming challenges associated with homelessness.

Key takeaways

Completing the Nevada DMV 128 form is a significant process for individuals experiencing homelessness who are seeking to have fees waived for a duplicate driver’s license, instruction permit, or identification card. Here are some key takeaways to help understand and navigate this process effectively:

  • The Nevada DMV 128 form is specifically designed to assist homeless individuals by waiving certain fees associated with obtaining a duplicate driver’s license, instruction permit, or identification card.
  • To qualify for a fee waiver under this form, applicants must certify their homeless status as per the criteria outlined in Nevada Revised Statutes Chapter 483.
  • This form allows for the fees to be waived one time only. Should applicants find employment by the time of their next renewal, they are required to reimburse the Department of Motor Vehicles (DMV) for the cost of the photo fee.
  • Applicants have the option to request a duplicate driver’s license, instruction permit, or identification card through this form, which must be clearly indicated in the designated section.
  • It is essential for applicants to provide accurate information, including their printed name, any known driver's license or identification card number, social security number, date of birth, and the current address where they are staying.
  • Male applicants between the ages of 18 and 26 are given the option to register with the Selective Service. This registration is crucial, as it keeps them eligible for federal student loans, grants, job training, most federal jobs, and, if applicable, U.S. citizenship.
  • The form requires the applicant’s signature under penalty of perjury, affirming that all provided statements and information are true and accurate, emphasizing the seriousness of the declaration.
  • Any misstatement of material facts can lead to the cancellation and/or denial of the application and may be subject to legal punishment, including misdemeanor or felony charges under NRS 483.530, with penalties outlined in NRS 193.130.

Navigating the process with the Nevada DMV 128 form is a straightforward way for homeless individuals to maintain or regain important personal identification documents without the financial burden. It's crucial for applicants to provide accurate information and understand the conditions and responsibilities associated with submitting this form.

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