Name
Date of Birth
NJ Driver's License Number or MVC Non-driver ID Number
If you DO NOT have a NJ Driver's License or MVC non-Driver ID, provide the last 4 of your Social Security Number.
"I swear or affirm that I DO NOT have a NJ Driver's License, MVC Non-driver ID or a SSN"
Home Address
Mailing Address
If different from Home Address.
Last Registered Address
Former Name
If making a name change.
Optional Questions
Gender
Male
Female
I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as official documentation and is subject to penalty for perjury.
Full Name:
Today's Date:
Submit
