State ID Application Form - City & County of Honolulu

Before completing the form below, please review the
State Identification Card Information and Requirements
found at: http://www1.honolulu.gov/csd/sid/sidinforeqs.htm

STATE OF HAWAII
IDENTIFICATION CARD APPLICATION
CHECK TRANSACTION REQUESTED: o INITIAL o RENEWAL o DUPLICATE
_ _ _ _
SID NUMBER SOCIAL SECURITY NUMBER DATE OF BIRTH (mm/dd/yyyy)
LAST FIRST MIDDLE
NAME
MAIL
ADDRESS
STREET OR P.O. BOX
APT. NO.
CITY
STATE/COUNTRY
ZIP CODE
HOME
ADDRESS
STREET ADDRESS
APT. NO.
CITY
STATE/COUNTRY
ZIP CODE
HEIGHT
FEET INCHES WEIGHT (LBS) COLOR HAIR COLOR EYES SEX o MALE
o FEMALE
DO YOU WISH TO BE AN o YES
ORGAN DONOR o NO
EMERGENCY
CONTACT
CONTACT
ADDRESS
CONTACT
TELEPHONE
DO YOU HAVE AN ADVANCE HEALTHCARE o YES
DIRECTIVE o NO
NAME (LAST, FIRST, M.I.) RELATIONSHIP
CITIZENSHIP
STREET OR P.O. BOX APT. NO. CITY STATE/COUNTRY ZIP CODE
AREA CODE NUMBER
_
OR
IDD PREFIX COUNTRY CODE NUMBER
I acknowledge that my social security number I am providing is required by Section 286-303(c)(7), Hawaii Revised Statutes. I further acknowledge that if I am unable to obtain a social
security number as evidenced by official notification by the Social Security Administration to the county examiner of drivers, a randomly generated alternate number shall be issued
by this agency for the sole purpose of providing me with a state identification card. NOTE: Your social security number or the randomly generated alternate number will NOT be the
State Identification card number printed on your card.
Federal law requires all male applicants between the ages of 18 through 25 to be automatically registered with the United States Selective Service System. By submitting this application
for the issuance of a state identification card, duplicate or renewal, the qualified applicant is consenting to registration with the United States Selective Service System, if so
required by Federal law.
I hereby certify, under penalty of perjury, that all the information provided is true and correct and that I am the person named and described in this application. I understand that
providing false information may be a violation of Federal and State Law
APPLICANT’S SIGNATURE _____________________________________________________________________ DATE ____________________________
AFFIDAVIT ON APPLICATION FOR VOTER REGISTRATION (STATE OF HAWAII RESIDENTS ONLY!!)
Do you wish to register to vote If “NO”, STOP! If “YES”, continue on.
Are you a registered voter in another state o YES o NO
If so, where _________________________________________________________________________________
Address/County/State/Zip (your voter registration will be cancelled in that state)
Home Phone ___________________________ Business Phone ______________________________________
For office use only
Affidavit Number
I.D. DL99 Loc. Code 98
FOR FEDERAL, STATE AND COUNTY ELECTIONS (you must meet all of the following qualifications to register to vote.)
I hereby swear or affirm that I am:
• A citizen of the United States: (Non-U.S. Citizens including U.S. Nationals do not qualify) .............................. o YES o NO
• At least 16 years of age ...................................................................................................................................... o YES o NO
However, I understand that I must be 18 years old by election day to vote; and
• A resident of the State of Hawaii ......................................................................................................................... o YES o NO
The residence in this affidavit is not simply because of my presence in the state, but that the residence was acquired with the intent
to make Hawaii my legal residence with all of the accompanying obligations therein.
ALL INFORMATION ON THIS AFFIDAVIT IS TRUE AND CORRECT.
Signature __________________________________________________ Date ____________________________
If you do not sign, we will assume you do not wish to register to vote.
WARNING: Any person knowingly
furnishing false information may be
guilty of a Class C felony punishable
by up to 5 years imprisonment
and/or $10.000 fine.
For election information, call the State of Hawaii Voter Hotline at 1-800-442-VOTE (8683)
The office at which a person registers to vote is confidential. A person’s declination to register to vote is confidential and is used for voter
registration purposes only (National Voter Registration Act of 1993). §11-15 Hawaii Revised Statues requires that a person registering to
vote provide, under affirmation, a social security number. Any application lacking this information will be denied. Pursuant to Section 7 of the
Privacy Act, be advised that this information may be released to government agencies for government pruposes.

Hawaii Driver License and State Identification Card Required Documents
Applicants for initial and renewal of driver’s license and state identification card are required to provide
original documents to prove Legal Name, Date of Birth, Social Security Number, Legal Presence, and
Principal Residence. Photocopies or faxes will not be accepted.
If your current name is different from the name shown on your documents (examples: due to marriage,
divorce, adoption, name change, naturalization), you will need to provide “connecting documents” to
establish the link between the names. See Alternate Acceptable Government Issued Documents for
Legal Name Change.
Acceptable Government Documents for Legal Name, Date of Birth and Legal Presence
Valid U.S. Passport or Passport Card
Valid Hawaii ID Card issued after 01-2013
Valid U.S. Jurisdiction DL/ID/Permit with Photo
U.S. State, Local Government issued Certificate of Birth or Birth Card. (In accordance with Puerto Rico
Law 191, Hawaii does not accept any Puerto Rican birth certified before July 1, 2010)
Consular Report of Birth Abroad
USCIS Form N-550, N-551, I-560, I-688, I-766, and Valid Foreign Passport with unexpired visa with
approved I-94
Alternate Additional Acceptable Government Issued Documents for Legal Name Change
Marriage Certificate
Civil Union Certificate
Court Order Name Change/Adoption/Divorce (Court seal required)
Alternate Additional Acceptable Documents for Legal Name and Date of Birth
Valid U.S. Military ID Card, Common Access Card, and DD Form 1173 (Card must contain photo with
printed name and date of birth)
Alternate Additional Acceptable Documents for Legal Presence
Valid TSA Transportation Worker Identification Credential
U.S. Department of Receptions and Placement Program Assurance Form (Refugee)
USCIS form I-797
Acceptable Documents for Social Security Number (Full social security number and name must be
printed on the document)
Social Security card
W-2, 1098 or 1099 (Electronic copy accepted)
Medicare Card (Suffix A, M, T, and TA only)
Pay stub
Valid U.S. Military ID Card, Common Access Card, and DD Form 1173 (Card must contain photo with
printed name and social security number)
Acceptable Documents for Principal Residence (Two documents required)
Documents must indicate the applicant’s name and same residence address. If the two documents are
not in the name of the applicant, complete the Affidavit for Proof of Residence by the documents’
addressee.
Vehicle Registration or Title
Hawaii Driver License/Permit
Utility Bill
Financial Institution Statement
Mortgage Account
Property Tax Assessment
W-2 Form Medical Insurance Card/Statement
Voter Registration Card
Student ID issued by Hawaii School
Rental/Time Share Agreement 6 months or more
Letter from Hawaii State Department of Human Services

Homeless may use address of current shelter agency or general delivery address verified by U.S. Post
Office.