Professional Documents
Culture Documents
International Driver's License Application
International Driver's License Application
1.
Last name:
Patterson
2.
First Name:
Timothy
3.
Current Driver's License
1802 Parkway Street
Address:
Apt. # 178
Apt. # 178
*****************
6.
Telephone:
215-649-0154
7.
*Passport #:
8.
*Passport Date of Issue#:
4/15/1999
9.
*Passport Place of Issue:
New Orleans, LA
10.
Place of Birth:
Baton Rouge, LA
11.
Date of Birth:
1/16/1979
12.
Nationality:
American
13.
Driver's License #:
a1234567
14.
State of Issue:
CA
15.
Date of Issue:
12/20/2005
16.
Expires On:
12/20/210
I understand that this international driver's license is in no way intended to replace a suspended
or revoked driver's license from the United States or any other country, and I am not applying for
this international driver's license to use as such. I do further understand that this international
driver's license will become null and void if a license is issued and the above is the actual
Intention of the applicant. I further release IDL International, Inc. from any and all said liability
caused by any misrepresentation on my part. I additionally release IDL International, Inc. from
any and all liability caused by applicant's failure to comply with any local, state, national, or
international law.
Timothy Patterson
17.Applicant Signature: * Not Mandatory
Credit cards (VISA, MasterCard or American Express) are accepted for YOUR convenience. All credit card
transactions will be billed an additional $5.00 per license to offset processing fees.