8/8/2019 Dl-31oll Extend the OLL Work License

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APPLICATION TO EXTEND AN

OCCUPATIONAL LIMITED LICENSE (OLL)

License number

AGeDATe OF birTH (t ltd)

moth Day Ya M FeYe cOLOr

Ft ih

HeiGHT

TeLepHOne number (tw 8:00 a.. - 4:30 ..)

A

currenT sTreeT ADDress: p.O. bo ay d addto to th atal add, t aot d a th oly add.

Zip cODesTATeciTY

Te Department is required to obtain te Licensee's eigt and eye color under te provisions of te Pennsylvania Veicle Code. Tis information wilbe used for identification purposes in an attempt to minimize driver license fraud.

CURRENT OCCUPATIONAL LICENSE (Type or print information from current OLL)

LAsT nAme miDDLe nAmeFirsT nAmeJr.,eTc.

Ceck te type of OLL currently issued to you.

LICENSE CLASS INFORMATION

Non-Commercial Non-Commercial wit Motorcycle

Fee: $13.50 *Fee: $18.50

* Te additional $5.00 fee is required by Act 31, of 1984, and is used to support a Motorcycle Safety Education Program in Pennsylvania.

C

ACKNOWLEDGMENT

X

WARNING: Misstatement of fact is a misdemeanor of te tird degree punisable by a fineof up to $2,500 and/or imprisonment up to one year (18 Pa C.S., Section 4904[b]).

I am asking for an extension of my OLL because of an additional suspension wic was added to my driving record after I received my initial OLL.

I certify under penalty of law tat all information given on tis application is true and correct. I confirm tat I ave received notice of teprovisions of Section 3709 of te Veicle Code.

I used a Messenger Service to assist me in completing tis form. I autorize te Department to give tis Messenger Service my drivingrecord information.

I wis to voluntarily contribute $1.00 to te Organ Donation Awareness Trust Fund. If cecked ere, include te $1.00 in te total fees

entered in te Fee Paid block.

D

FEEPAID $

moth Day Ya

License expirATiOn DATe

APPLICANT'S SIGNATURE IN INK DATE

(See Section C for fees)

This Area For

CHANGE

or

CORRECTION

ONLY

NEW STREET ADDRESS:

ADDRESS CHANGE: A Post Office Box number may be used in addition to te actual address, but cannot be used as te only addressSee reverse if using an out-of-state address.

CITY STATE ZIP CODE

B

NEW OR CORRECT DATA - Complete this section if you desire to change or correct your address.

If you are a registered voter in PA, would you like us to notify your county voter registration office of this change? qYES qNOIf you are not a registered voter, you may contact your county voter registration office.

DL-31 OLL (12-10)

PLEASE TYPE OR PRINT IN bLUE OR bLACK INK ALL INFORMATION

sex e-mAiL ADDress: (if applicable)

EYE COLOR(Please check one): bLUE bROWN GREEN HAZEL PINK bLACK GRAY DICHROMATIC OTHER_______________

Bureau of Driver Licensing

P.O. Box 68689

Harrisburg, PA 17106-8689DEPARTMENT OF TRANSPORTATION

8/8/2019 Dl-31oll Extend the OLL Work License

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INSTRUCTIONS FOR COMPLETING

OLL EXTENSION APPLICATION

Carefully read and follow te instructions below to complete te Occupational Limited License Extension Application. TeApplication must be complete and accurate for your request to be considered.

1. SECTION A - Fill in all blocks using your current Occupational Limited License (OLL). Be sure to write te informationexactly as it appears on your OLL. Please provide a daytime telepone number (between 8:00am and 4:30pm, Mondaytroug Friday) were te PA Department of Transportation can reac you, if necessary, to get additional information toprocess your Application.

2. SECTION b - Complete tis section if you desire to cange or correct your address.

OUT-OF-STATE ADDRESS ChANGE. Driver license products cannot be issued to an out-of-state address, exceptin te case of an employee of federal or state government, armed forces personnel, or teir families, woseworkplace is located outside of Pennsylvania. If tis exception applies to you, please ceck te appropriate boxand include documentation of your status wit tis application.

I certify tat my workplace is located out of state and I am employed by, or am te immediate family of a personemployed by:

US Armed Forces Federal Government Pennsylvania State Government

Realtionsip to person meeting exemption (ceck one): Spouse Dependent Cild

3. SECTION C - Ceck a box to indicate te type, or class, of OLL currently issued to you.

4. SECTION D - Read tis section before signing. Once you ave read and understand te information, sign your name inink on te line provided. Your application will be rejected if it does not include your signature. If you used a MessengeService, suc as an automobile club or notary public, to elp you complete tis form, place a ceck in te box providedIf you wis to voluntarily donate $1.00 to te Organ Donation Awareness Trust Fund, place a ceck in te box provided

5. Once you ave completed te application, send it along wit a ceck or money order to te address below. Te ceckor money order sould be for te exact amount you owe and made payable to te PennDOT.

6. Wen your application is approved by te Department, you will be sent a new Camera Card and Autorization LetterOnce you receive tis Camera Card, take it to a Poto Driver's License Center to ave your picture taken. A new OLLwill be issued at tat time. Begin using tis new OLL immediately as te old OLL will no longer be valid. You soulddestroy your old OLL.

If you ave any questions, please write to te PA Department of Transportation at te address below. In order to providean immediate response, please include your daytime telepone number.

PA Department of TransportationBureau of Driver LicensingOLL/PL UnitP.O. Box 68689harrisburg, PA 17106-8689

PROVISIONS OF SECTION 3709 OF THE VEHICLE CODE

Section 3709 provides for a fine of up to $300 for dropping, trowing or depositing, upon any igway, or upon any oter public or private

property witout te consent of te owner tereof or into or on te waters of tis Commonwealt, from a veicle, any waste paper, sweepings,

ases, ouseold waste, glass, metal, refuse or rubbis or any dangerous or detrimental substance, or permitting any of te preceding witou

immediately removing suc items or causing teir removal.

For any violation of Section 3709, I may be subject to a fine of up to $300 upon conviction, including any violation resulting from te conduct of

any oter persons present witin any veicle of wic I am te driver.

DL-31 OLL (12-10)