Change of address form dmv

%PDF-1.3 %�� 1 0 obj > endobj 4 0 obj [ /PDF /Text ] endobj 6 0 obj > stream BT /F0 8 Tf 0 g 141.76 498.169 Td (If you provide an e-mail address, your registration) Tj 0 -9.176 Td (renewal notices will) Tj /F1 8 Tf ( only ) Tj /F0 8 Tf (be sent to your e-mail.) Tj ET q 139.501 38.137 25.999 26.515 re W n 26 0 0 26 139.671 38.565 cm /im0 Do Q .82 g 117.507 22.116 17.243 299.648 re f 117.026 337.397 17.864 384.163 re f BT /F1 8 Tf 0 g 209.993 764.328 Td (STATE OF CONNECTICUT) Tj -21.555 -9.176 Td (DEPARTMENT OF MOTOR VEHICLES) Tj -160.038 8.989 Td (B-58 IND Rev. 10-2019) Tj ET .50 w 0 G 2 J 1 g 430.087 729.380 158.618 42.236 re B BT 0 g 436.096 760.476 Td (FOR DMV INTERNAL USE ONLY) Tj ET 2 J 1 g 436.487 747.329 8.067 8.07 re B BT /F0 7 Tf 0 g 449.697 749.055 Td (LICENSE/ID CHANGES COMPLETED) Tj 0.164 -13.459 Td (REGISTRATION CHANGES COMPLETED) Tj /F0 8 Tf -423.468 -5.02 Td (Please mail completed form to:) Tj /F1 8 Tf ( DMV Change of Address Unit, 60 State Street, Wethersfield, CT 06161-1015) Tj /F1 9 Tf 0.706 11.387 Td (Individual Change of Address/Organ & Tissue Donor Status/Voter Registration Application) Tj ET 2 w 0 J 26.646 721.53 m 585.771 721.53 l S .50 w 0 J 27.575 668.245 m 586.7 668.245 l S BT 28.61 708.367 Td (About You) Tj ET .60 w 0 J 45.456 694.193 m 62.782 694.193 l S BT /F0 8 Tf 28.993 695.191 Td (You ) Tj (must) Tj ( provide your) Tj 0 -9.176 Td (name, license/ID) Tj 0 -9.176 Td (number and birth date.) Tj ET .50 w 0 J 116.989 721.242 m 116.989 22.076 l S 0 J 134.575 721.4 m 134.575 22.181 l S BT /F1 12 Tf 122.627 690.38 Td (1) Tj ET 0 J 134.824 694.879 m 586.324 694.879 l S 0 J 456.698 721.44 m 456.698 694.947 l S BT /F1 7 Tf 139.890 713.721 Td (NAME) Tj /F0 7 Tf ( $Last, First, Middle$) Tj /F1 7 Tf 321.248 -0.351 Td (BIRTH DATE) Tj -321.622 -26.399 Td (OPERATOR LICENSE/ID NUMBER) Tj 284.482 0.485 Td (TELEPHONE NUMBER) Tj ET 0 J 27.575 588.379 m 586.7 588.379 l S 0 J 134.824 615.078 m 586.324 615.078 l S BT /F1 9 Tf 28.236 642.532 Td (Your Residence) Tj 0 -10.324 Td (Address) Tj /F0 8 Tf 0.383 -13.578 Td (This must be a) Tj 0 -9.176 Td (Connecticut address.) Tj 0 -1.670 Td /F1 12 Tf 94.479 15.987 Td (2) Tj /F1 7 Tf 17.167 37.012 Td (STREET ADDRESS) Tj 187.668 0.009 Td (UNIT/APT. #) Tj -184.646 -26.569 Td (CITY) Tj 252.181 0.011 Td (STATE) Tj /F1 10 Tf 4.507 -13.572 Td (CT) Tj /F1 7 Tf 90.425 13.578 Td (ZIP CODE) Tj /F1 10 Tf -0.13 -13.294 Td (06) Tj /F1 8 Tf -350.008 -14.017 Td (DMV shares residence address updates with town registrars) Tj 0 -7.999 Td (of voters so they can update your voting address, if you are) Tj 0 -7.999 Td (a registered voter.) Tj /F0 8 Tf 255.206 12.719 Td (Check here if you do ) Tj /F1 8 Tf (NOT ) Tj /F0 8 Tf (want your voting address) Tj 0 -9.176 Td (automatically updated.) Tj ET 0 J 27.201 535.445 m 586.327 535.445 l S BT /F1 9 Tf 28.613 574.835 Td (Your Mailing) Tj 0 -10.324 Td (Address) Tj /F1 7 Tf 111.651 16.345 Td (STREET ADDRESS) Tj 187.325 0.009 Td (UNIT/APT. #) Tj ET 0 J 26.824 509.049 m 585.950 509.049 l S BT /F1 9 Tf 28.236 524.058 Td (Organ and Tissue) Tj 0 -10.324 Td (Donor Status) Tj /F1 12 Tf 94.41 43.764 Td (3) Tj -0.190 -40.003 Td (4) Tj /F0 8 Tf 34.393 6.137 Td (I consent to organ and tissue donation) Tj 0 -9.176 Td (and wish to be in the donor registry) Tj 166.618 8.439 Td (I no longer wish to be in the donor registry) Tj ET 0 J 26.447 470.095 m 585.573 470.095 l S BT /F1 9 Tf 27.113 491.766 Td (Your E-mail) Tj 0 -10.324 Td (Address) Tj /F1 12 Tf 95.343 4.042 Td (5) Tj ET 0 J 134.765 483.854 m 586.264 483.854 l S BT /F0 8 Tf 154.137 474.197 Td (Check here to remove an e-mail address already on file and have your registration renewal reminders sent to you by mail.) Tj ET 0 J 26.447 364.13 m 585.573 364.13 l S 0 J 134.768 443.324 m 586.267 443.324 l S 0 J 134.824 416.837 m 586.324 416.837 l S 0 J 134.765 390.317 m 586.264 390.317 l S BT /F1 7 Tf 140.264 462.348 Td (PLATE/VESSEL NO:) Tj -0.003 -26.58 Td (PLATE/VESSEL NO:) Tj 0 -26.507 Td (PLATE/VESSEL NO:) Tj 123.018 53.099 Td (ADDRESS) Tj -0.006 -26.58 Td (ADDRESS) Tj -0.003 -26.504 Td (ADDRESS) Tj /F1 9 Tf -236.157 51.406 Td (Your) Tj 0 -10.324 Td (Vehicles/Vessels) Tj ET q 25.5 419.695 25.999 26.515 re W n 26 0 0 26 25.67 420.123 cm /im1 Do Q .68 w 0 J 25.620 407.211 m 50.621 407.211 l S BT 25.620 408.334 Td (ONLY) Tj /F0 9 Tf ( list) Tj 0 -10.324 Td (vehicles/vessels) Tj 0 -10.324 Td (garaged somewhere) Tj 0 -10.324 Td (other than your new) Tj 0 -10.324 Td (residence address.) Tj 0 -1.879 Td /F1 8 Tf 115.138 15.616 Td ($List any additional vehicles on a separate sheet and attach it to this form.$) Tj 0.003 -11.718 Td (*All vehicles will be changed to your new residence address unless specified here.*) Tj /F1 12 Tf -18.36 43.566 Td (6) Tj /F1 9 Tf -95.406 -64.936 Td (SIGNATURE) Tj ET .50 w 0 J 440.957 363.832 m 440.957 337.484 l S BT /F1 12 Tf 121.774 346.448 Td (X) Tj /F1 7 Tf 322.566 10.071 Td (DATE) Tj ET .82 g 26.73 323.75 558.397 14.499 re f 2 w 0 J 26.365 337.564 m 585.49 337.564 l S .50 w 0 J 134.71 271.987 m 586.21 271.987 l S BT /F0 8 Tf 0 g 141.398 311.346 Td (Are you a citizen of the United States of America?) Tj 196.571 0.014 Td (YES) Tj 35.929 0.011 Td (NO) Tj -232.444 -13.008 Td (Will you be at least 18 years of age on or before election day?) Tj 239.664 -0.09 Td (YES) Tj 35.929 0.011 Td (NO) Tj /F1 8 Tf -276.146 -12.458 Td (If you checked "NO" in response to either of these questions, do NOT complete below this line as you cannot) Tj 0 -9.176 Td (register to vote.) Tj ET 0 J 134.572 182.823 m 586.072 182.823 l S BT /F1 11 Tf 58.170 238.360 Td (Voter) Tj -18.023 -12.617 Td (Registration) Tj 2.137 -12.617 Td (Application) Tj 10.086 -12.617 Td (Section) Tj /F1 8 Tf 88.452 58.697 Td (Do you wish to enroll in a political party?) Tj 14.204 -15.625 Td (YES) Tj /F0 8 Tf 23.38 0.488 Td (NAME OF PARTY:) Tj 91.868 -0.476 Td (DEMOCRATIC) Tj 75.832 0.011 Td (REPUBLICAN) Tj 72.34 0.014 Td (OTHER:) Tj ET 0 J 449.643 237.86 m 588.124 237.86 l S BT /F1 8 Tf 155.268 226.480 Td (NO) Tj ET .60 w 0 J 420.542 225.493 m 477.439 225.493 l S BT /F0 8 Tf 178.214 226.491 Td (I do not wish to enroll in a party at this time and will be registered as ) Tj (UNAFFILIATED) Tj (.) Tj -37.996 -14.403 Td (Note: Declaring a party enables you to vote in the party's primary election, which is open only to party members.) Tj 0 -9.176 Td (You may later choose to switch enrollment to or from a political party.) Tj /F1 8 Tf -0.374 -13.839 Td (LEAVING THIS BOX BLANK WILL AUTOMATICALLY RESULT IN SELECTING "UNAFFILIATED".) Tj 1.310 -19.066 Td (VOTER DECLARATION - ) Tj /F0 8 Tf (I swear or affirm under penalty of perjury that:) Tj 9.227 -14.202 Td (* I am a U.S. Citizen;) Tj 0 -11.999 Td (* I am at least 17 years old and will be at least 18 years old on or before election day;) Tj 0 -11.999 Td (* I live in Connecticut at the address shown above;) Tj 0 -11.999 Td (* I have not been convicted of a disenfranchising felony, or if so, I am eligible to register to vote.) Tj 0 -4.493 Td /F1 8 Tf -9.411 -8.705 Td (The information that I have provided is true to the best of my knowledge under penalty of perjury. If I have) Tj 0 -9.176 Td (provided false information, I may be subject to a fine or imprisonment or both under federal or state laws.) Tj 0 -1.670 Td /F0 8 Tf 0.380 -12.728 Td (By signing this Voter Declaration, I am applying to register to vote or changing my existing party affiliation, and I agree) Tj 0 -9.176 Td (to allow the signature from my license record to be used as the signature on my voter registration record.) Tj ET .50 w 0 J 135.074 67.249 m 586.573 67.249 l S 0 J 134.572 35.73 m 586.072 35.73 l S 0 J 460.959 66.725 m 460.959 35.374 l S BT /F1 7 Tf 464.34 59.411 Td (DATE SIGNED) Tj ET .53 w 0 J 320.119 56.65 m 339.565 56.65 l S BT 179.337 57.523 Td (SIGNATURE FOR VOTER REGISTRATION ) Tj /F2 7 Tf (ONLY) Tj ( ) Tj /F1 7 Tf (**) Tj /F1 9 Tf -7.846 0.181 Td (X) Tj ET 2 w 0 J 26.575 22.082 m 585.7 22.082 l S BT 140.624 26.07 Td (** Voter registrations without signatures will not be processed.) Tj ET .68 w 0 J 31.331 163.485 m 56.333 163.485 l S BT 31.331 164.608 Td (ONLY) Tj /F0 9 Tf ( complete this) Tj 0.995 -10.324 Td (section if you would) Tj -2.256 -10.324 Td (like to apply for voter) Tj 2.001 -10.324 Td (registration or if you) Tj -4.246 -10.324 Td (are already registered) Tj 5.74 -10.324 Td (to vote and want to) Tj -2.999 -10.324 Td (change your political) Tj 10.766 -10.324 Td (party affiliation.) 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Tj 0 -1.670 Td /F1 8 Tf -0.454 -212.666 Td (DO NOT COMPLETE BELOW THIS LINE UNLESS YOU WANT TO REGISTER TO VOTE OR CHANGE YOUR POLITICAL PARTY AFFILIATION.) 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