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Get IA 430152 2007-2024

E a resident in the State of Month/Day/Year 2. My current address is: City State ZipCode 3. I applied for a driver license in the state listed above on the following date: Month/Day/Year 4. My date of birth is: Month/Day/Year 5. My Iowa Driver License number or Social Security Number (SSN) is: THE AFFIANT DOES HEREBY SWEAR AND ATTEST THAT THE AFOREMENTIONED STATEMENTS ARE TRUE AND CORRECT UNDER THE PENALTIES OF PERJURY. SIGNATURE THE FOLLOWING INFORMATION MUST BE COMPLETED BY AN OFFICIAL.

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