NEW, RENEWAL AND REPLACEMENTS PERMIT, CLASS O (Car), CLASS M (Motorcycle) and STATE ID CARD DATA FORM

Sep 20, 2026

Uploaded by Ben

This document is a Nebraska state data form for New, Renewal, and Replacement permits and identity cards, covering Class O (Car) permits, Class M (Motorcycle) permits, and a State ID Card. It collects applicant identity information (name, address, date of birth, social security number), physical details (height, weight, eye and hair color, gender), and includes attestation regarding lawful status under Neb. Rev. Stat. 60-484.04. It also includes optional motor voter registration choices, veteran designation requests, state ID issuance for voting, organ and tissue donation questions, and health screening questions for driving privileges.

LanguageEnglish

CategoryExam

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Applicant Information

Contact and Identity Fields

Physical Characteristics

Legal Status Attestation

Motor Voter and Veteran/ID Options

Party Affiliation and Voter Registration

Veteran Designation and State ID for Voting

Organ and Tissue Donation

Driving Privilege Health Questions

NEW, RENEWAL AND REPLACEMENTS PERMIT, CLASS O (Car), CLASS M (Motorcycle) and STATE ID CARD DATA FORM | COMPLETE INFORMATION – PLEASE PRINT
Email Address: Cell Phone Number: | | | | | | | Date of Birth | | | | | Social Security Number | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | | | | | | | | Month | Day | | Year | | | | | | | | | | | | | | | | | | | | | | | | LAST NAME | | | | | FIRST NAME | | | | | | | MIDDLE INITIAL | | | SUFFIX (JR, SR, 1ST, 2ND, 3RD) | | CURRENT RESIDENTIAL ADDRESS REQUIRED (Street address or Route and PO Box, Apt \#) | | | | | | CITY | | | | | | | | STATE | ZIP CODE | | CURRENT MAILING ADDRESS (If different from residential address) | | | | | | CITY | | | | | | | | STATE | ZIP CODE | | COUNTY
NUMBER | GENDER | HEIGHT | | WEIGHT | | EYE
COLOR | | | HAIR
COLOR | | RACE | | | | | | | | FT. | IN. | | | | | | | | | | | | | | | M
F | | | | | | | | | | BLACK
WHITE | | AMERICAN INDIAN OTHER ASIAN OR PACIFIC ISL HISPANIC | | | For the purposes of complying with Neb. Rev. Stat. 60-484.04, I attest: I am a citizen of the United States OR I am not a citizen of the United States, but do have lawful status and agree to provide valid documentary evidence of such as outlined in 60-484.04 Yes Yes No No Please answer the following questions for motor voter, veteran designation, and State Identification Card for voting purposes (answers are optional). Ifyou decline to register to vote, that fact will remain confidential and will only be used for voter registration purposes. Ifyou choose to register to vote, the office at which you submitted a voter registration application will remain confidential and will be used only for voter registration purposes. If you are already registered to vote in Nebraska, the change of address information on this application will be used to automatically update your voter registration information. Check here if you do not want your voter registration updated 􀀀 1A. Do you wish to register to vote as part of this application process? (You only need to re-register ifyou have changed your name or political party.) ........................................................................................................................................... Yes__ No__ 1A1 . Party Affiliation: Republican Democratic Libertarian Legal Marijuana Now Nonpartisan (no party) Other 1A2 . Last Registration Address City: County or State 1B. Do you wish to have a veteran designation displayed on the front of your operator’s license or state identification card to show that you served in the armed forces of the United States? .................................................................................... Yes__ No__(To be eligible you must register with the Nebraska Department of Veterans’ Affairs Registry). 1C. Do you wish to request issuance of a State Identification Card for voting purposes? ....................................................... Yes__ No__ Please consider the following organ and tissue donation questions. 2. Do you wish to include your name in the Donor Registry of Nebraska and donate your organs and tissues at the time of your death? ..................................................................................................................................................................... Yes__ No__ 3. Do you wish to receive any additional specific information regarding organ and tissue donation?................................... Yes__ No__ 4. Do you wish to donate $1 to promote the Organ and Tissue Donor Awareness and Education Fund? Yes__ No__ Please answer the following questions if you are applying for a document with driving privileges. 5. Have you within the last three months (e.g. due to diab

FAQs

What personal information does the form request?

It requests the applicant’s name, date of birth, social security number, email address, cell phone number, residential and mailing addresses, and physical characteristics such as height, weight, eye color, hair color, gender, and race.

What attestation statement is included for Neb. Rev. Stat. 60-484.04?

The form requires attesting whether the applicant is a U.S. citizen or, if not a citizen, that the applicant has lawful status and will provide valid documentary evidence as outlined in 60-484.04.

What optional choices are available for motor voter and related designations?

For motor voter, it asks whether the applicant wants to register to vote and includes party affiliation and prior registration address fields. It also offers options for a veteran designation on the license/ID and requesting issuance of a State Identification Card for voting purposes.

Sep 20, 2026

Uploaded by Ben