31 Miss. Code. R. 1-2.6 - Instructions for Completing the Application for Mississippi Driver License or Temporary Permit - Form DL-4

1. Full Name - Full name must be typed or printed in (preferably black) ink. Do not use nicknames, etc. The full name appearing on the legal birth certificates (except married women) must be used. If a female student is married, place the maiden name in proper space. She must provide original marriage license.

2. Social Security Number - The Department of Public Safety requires that each applicant insert his/her Social Security Number in the proper space. The Social Security Number is used as the driver license number. Many students do not have Social Security Numbers. Driver education teachers may obtain the number of applications needed from local Social Security districts or branches or:

Social Security Administration

Post Office Box 2249

Jackson, MS 39205

Telephone: 601-960-5001

The test will not be administered unless the Social Security card is presented. When students complete the driver education course and apply to the Mississippi Highway Patrol to take the road test, they must have a DL-4 application and temporary permit. Helping students now to obtain the same will greatly help the Mississippi Highway Patrol administer the driver license program.

3. Mailing address, Number and Street - Complete address must be given. Example: 938 South State Street, Jackson, MS 39201. (Number, street, city, state and zip code). If home address is the same as mailing address, write the word the same in that place.

4. Race - Use the following abbreviations:

W- White B- Black Y- Oriental I- Indian O- Other

5. Hair - Natural color of hair must be given.

6. Questions - Applicants must answer all questions. If the answer is yes, be sure the applicant fully explains each yes answer.

7. Signature of Applicant - Original signature (usual signature of applicant) must be used.

8. Signature(s) of Parent, Guardian, or Responsible Person(s) - The person(s) signing the responsible affidavit must appear before a notary public and sign their usual signature. This must be signed in ink. Listed below are the regulations applicable to signatures.

a. One parent Deceased- Write word DECEASED on appropriate line; only one (1) signature is required.

b. Parents Legally Divorced- Write words DIVORCED on appropriate line; only one (1) signature is required.

d. Parents Legally Separated- Write words LEGALLY SEPARATED on appropriate line; only one (1) signature is required.

e. Parents NOT Legally Separated- Both parents must sign the responsibility affidavit, this may be handled in different ways:

i. Both parents, at different times or together, may appear before a notary public and place their signature on the same application card.

ii. If parents are separated by distance, one in Jackson, one in another city or state, mail the application to the parent not at home with a note requesting the form be notarized and mailed back to the home address.

iii. Formal power of attorney documents must be presented.

9. Birth Certificate Number - A certified birth certificate must be presented. Hospital certificates and Baptismal certificates cannot be accepted. (Birth certificates that have not been certified will not carry a number). Passports and/or legal immigration papers will be accepted to offset birth certificates written in a foreign language.

10. Operators License Numbers - Be sure the person signing the affidavit enter their license number in the correct space. If they do not have a license, the word NONE should be entered.

11. In the event of seizure disorder, drug addiction, or mental disorder, a DR-11 (medical form) will be provided. It must be taken to a doctor for completion and mailed to the address specified. Mississippi Highway Patrol officials will respond in writing for approval or disapproval. The applicant would not be able to test until the DR-11 is approved by the Department of Public Safety.

Notes

31 Miss. Code. R. 1-2.6

Miss. Code Ann. § 45-1-3