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The DL-16Lc form is a crucial document for individuals facing the suspension, revocation, disqualification, or cancellation of their driving privileges in Pennsylvania. Designed to facilitate the acknowledgment of such changes, the form requires detailed information from the applicant, such as their driver's license or permit number, name, and date of birth. Completing the form accurately is essential; all sections must be filled out, and a signature is mandatory. Failing to comply may result in a denial of credit for the suspension. Additionally, if a person possesses a valid driver's license or permit, they are required by law to surrender it before receiving suspension credit. The form also provides the opportunity to update residential addresses, which can impact voter registration as well. Since the submission process involves mailing the completed document to the Pennsylvania Department of Transportation (PennDOT), timely action is vital. Upon acceptance, the applicant will receive a receipt confirming their suspension credit, making it imperative to follow through diligently. Understanding the nuances of the DL-16Lc form can significantly affect a person's ability to navigate their suspended driving status and comply with state regulations.

Form Sample

PLEASE PRINT

DL-16LC (12-21)

ACKNOWLEDGMENT OF SUSPENSION/ REVOCATION/DISQUALIFICATION/CANCELLATION

AS REQUIRED UNDER SECTION 1541 OF THE VEHICLE CODE

PLEASE TYPE OR PRINT IN BLUE OR BLACK INK ALL INFORMATION

Bureau of Driver Licensing • P.O. Box 68693 • Harrisburg, PA 17106-8693

If you have a valid License, Permit(s) and/or Camera Card in your possession, you MUST surrender the valid product to the Department. You may not retain your PA Driver's License for photo identification purposes. This form may ONLY be used under the circumstances listed in Section B. ALL information in Section A, B, & C MUST be completed with a Signature and Date.

A

B

C

D

PA DRIVER'S LICENSE/PERMIT NUMBER

 

LAST NAME

JR.,ETC.

FIRST NAME

MIDDLE NAME

 

 

 

 

 

 

 

DATE OF BIRTH (must be listed)

TELEPHONE NUMBER

E-MAIL

ADDRESS (if applicable)

 

 

Month

Day

Year

( 

      )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHANGE OR CORRECTION ONLY

ADDRESS CHANGE:  A POST OFFICE BOX NUMBER MAY BE USED IN ADDITION TO THE ACTUAL RESIDENCE ADDRESS, BUT CANNOT BE USED AS THE ONLY ADDRESS.

NEW

STREET

ADDRESS

CITY

STATE

ZIP CODE

 

 

 

This application will also serve as a request to update your voter registration unless you check this box:

If you are not registered to vote, you will receive an application to register. You must be a U.S. citizen to register to vote in Pennsylvania.

You MUST mark the appropriate box(es) and provide the requested information.

1.Never licensed in Pennsylvania.

2.License, Permit(s) and/or Camera Card issued by Pennsylvania is:

Expired

Lost

Stolen

Mutilated:  When?_______________________________________________________________________________

Surrendered to or confiscated by the Police.  When: ____________________________________

What Police Department?_________________________________________________________________________

3.Other: You must indicate the reason that you are unable to surrender your valid License, Permit(s) and/or Camera

Card if items 1 or 2 do not apply: (If you have a valid PA Driver's License you may not retain it for photo identification

purposes):________________________________________________________________________________________

_ _______________________________________________________________________________________________

ACKNOWLEDGMENT

I,_ _________________________________  hereby acknowledge that my driving privilege is Suspended/Revoked/Disqualified in Pennsylvania.

AND

I certify that all information given on this acknowledgment is true and correct. I understand that upon restoration, I will be required to apply for the issuance, renewal, or replacement of my Driver's License, Learner's Permit, or Camera Card, whichever is needed, in order to be licensed in Pennsylvania. If using a messenger service, I hereby authorize the Department to furnish them with my driving record for the purpose of pro- cessing this form.

X

_ ______________________________

SIGNATURE IN INK

DATE

WARNING: Misstatement of fact is a misdemeanor of the third degree punishable by a fine of up to $2,500.00 and/or imprisonment up to one year (18 PA C.S. Section 4904(b)).

ADDITIONAL INFORMATION

Unless this document is being submitted by a Court of Record following sentencing, this form must be mailed to:

PennDOT  •  Bureau of Driver Licensing  •  P.O. Box 68693  •  Harrisburg, PA 17106-8693

Upon receipt, review and acceptance of this acknowledgment, PennDOT will send you a receipt. If you do not receive this receipt within 3 weeks of your mailing, please contact PennDOT at the telephone numbers listed below:

Visit us at www.dmv.pa.gov or call us at717-412-5300. TTY callers - please dial 711 to reach us

Document Specifications

Fact Name Description
Purpose of Form The DL-16LC form is used in Pennsylvania for the acknowledgment of suspension, revocation, disqualification, or cancellation of a driver's license as required by Section 1541 of the Vehicle Code.
Submission Requirements All sections of the form must be completed and signed. Failure to do so will result in no credit being given for the acknowledged suspension status.
Surrender of License If a valid driver’s license, permit, or camera card is held, it must be surrendered to earn credit toward the suspension. Retaining the license for identification purposes is not allowed.
Notification to Voter Registration Individuals who are registered voters in Pennsylvania may request that their county voter registration office be notified of any address changes as part of the DL-16LC submission.
Punishment for Misstatement Providing false information on the DL-16LC form is deemed a misdemeanor in Pennsylvania. This can result in fines up to $2,500 and/or imprisonment for up to one year, as per 18 PA C.S. Section 4904(b).

Steps to Filling Out Dl 16Lc

Completing the DL-16LC form requires careful attention to detail to ensure that all necessary information is accurately provided. This form is crucial for individuals undergoing license suspensions, revocations, or related issues in Pennsylvania. Following these steps closely will help streamline the process of submitting the form correctly.

  1. Obtain a blank DL-16LC form. This can be done online or by visiting the Bureau of Driver Licensing.
  2. Use blue or black ink to fill out the form legibly. Avoid using pencil or other colors.
  3. In Section A, enter the following personal information:
    • Your Pennsylvania Driver's License/Permit Number.
    • Your last name, first name, and middle name.
    • Your date of birth (month, day, year).
    • Your telephone number.
    • Your email address (if applicable).
  4. Proceed to Section B. Mark the box indicating your situation:
    • “Never licensed in Pennsylvania.”
    • If you have a license, permit, or camera card issued by Pennsylvania, indicate if it is expired, lost, stolen, or mutilated along with the relevant details.
    • If surrendered to the police, provide the date and name of the police department.
    • If none of these apply, explain the reason for not being able to surrender your valid license, permit, or camera card.
  5. For address changes in Section C, provide your new street address, city, state, and zip code. If necessary, include a post office box number in addition to your actual address.
  6. Indicate whether you would like to notify your county voter registration office of any changes if you are a registered voter.
  7. Sign and date the acknowledgment section. Ensure the signature is in ink.
  8. Double-check that all sections are completed, and ensure your signature and date are present. Incomplete forms may delay processing.
  9. Mail the completed form to:

    PennDOT
    Bureau of Driver Licensing
    P.O. Box 68693
    Harrisburg, PA 17106-8693

  10. If you do not receive a receipt within three weeks, reach out to PennDOT at the provided contact numbers to verify the status of your submission.

More About Dl 16Lc

What is the purpose of the DL-16Lc form?

The DL-16Lc form serves as an acknowledgment of the suspension, revocation, disqualification, or cancellation of a driver's license in Pennsylvania. This form is necessary for individuals whose driving privileges have been affected. By completing and submitting this form, individuals can secure credit for their suspension and ensure that their driving record is updated appropriately with the Bureau of Driver Licensing.

Who should complete the DL-16Lc form?

Anyone whose driving privileges have been suspended, revoked, disqualified, or canceled in Pennsylvania should complete the DL-16Lc form. This includes individuals who have lost their driver’s license due to various reasons such as DUI offenses, failure to pay fines, or other infractions that result in driving privilege penalties. It is also essential for individuals who must surrender their valid Pennsylvania driver’s license or permit for credit.

What information is required on the DL-16Lc form?

Completion of the DL-16Lc form requires several pieces of information. This includes the individual's Pennsylvania driver's license or permit number, full name, date of birth, and contact details like telephone number and email address. Sections A, B, and C of the form must be filled out in full, along with the individual's signature and date. Failure to provide complete information may result in the denial of credit for the suspension.

What should I do if I do not receive a receipt from PennDOT after submitting the DL-16Lc form?

If an individual does not receive a receipt confirming that credit has begun within three weeks of submitting the DL-16Lc form, they should contact the Pennsylvania Department of Transportation (PennDOT) to verify the status of their application. PennDOT has specific contact numbers for inquiries, including separate lines for in-state and out-of-state residents.

Can someone else submit the DL-16Lc form on my behalf?

Common mistakes

  1. Inaccurate Personal Information: Many individuals fail to provide accurate details such as their full name, date of birth, or address. This can lead to processing delays. Ensure all personal information is correct and matches your identification documents.

  2. Incomplete Sections: It is common for people to overlook sections A, B, and C of the form. All required fields must be filled out completely. If any information is missing, credit for suspension may not be processed.

  3. Improper Signature: Submitting the form without a signature or with an unsigned acknowledgment can lead to rejection. A handwritten signature in ink is necessary to confirm your application.

  4. Ignoring Notification Options: When asked if you would like your county voter registration office notified of changes, many neglect to check the appropriate box. This can complicate your registration process, especially if your address has changed.

Documents used along the form

The DL-16LC form is a crucial document for individuals in Pennsylvania whose driver's licenses have been suspended, revoked, disqualified, or canceled. To facilitate various processes related to driving privileges, several other forms and documents may often be used alongside the DL-16LC form. Understanding what these documents are and their purposes can help individuals navigate the complexities of driver licensing more effectively.

  • Form DL-15: This form is used to apply for a duplicate driver’s license when the original has been lost, stolen, or damaged. It helps ensure that individuals have a valid form of identification on hand.
  • Form DL-80: This is the application for a new driver’s license, typically used when an individual moves to Pennsylvania or is applying for a license for the first time. It is essential to establish legal driving eligibility.
  • Form DL-61: This form serves as a notice of suspension. It informs individuals of the specific reasons for their suspension and any related penalties, enabling them to understand the situation better.
  • Form DL-143: Known as the driver improvement program application, this document is often necessary for individuals looking to reduce points on their driving record through safety courses.
  • Form DL-81: This document is a request for an administrative hearing, allowing individuals to contest their suspension or revocation in front of a hearing officer, thereby providing an opportunity for a fair review of their case.
  • Form DL-93: This is the application for reinstatement of driving privileges after a suspension period. Completing this form is an essential step to regain legal driving status.
  • Form DL-960: The SR-22 certificate of insurance is required for individuals whose license has been suspended due to certain violations. It acts as proof that they are insured, a necessity for reinstatement.
  • Form DL-5: This is a notification of address change. Individuals must complete it when their residence changes to keep their records updated and ensure they receive important correspondence.
  • Form DL-20: This is a medical evaluation form that may be required if there are concerns regarding an individual's health affecting their ability to drive safely. Submitting this form helps maintain public safety on the roads.

Each of these documents plays an important role in the process of managing driving privileges in Pennsylvania. Properly utilizing them can greatly benefit individuals facing issues with their driving status, ultimately leading to more informed and responsible decisions regarding their ability to drive legally.

Similar forms

The DL-16LC form is similar to the SR-22 form, which is used to certify that a driver has the necessary insurance coverage after certain violations. Both forms serve to verify compliance with legal requirements regarding driving privileges. In the case of the SR-22, it often follows a suspension or revocation, demonstrating that the individual is taking steps to reinstate their driving status. Just like the DL-16LC, the SR-22 necessitates accurate information and signatures to ensure validity and compliance with state laws.

Another document akin to the DL-16LC is the PBM (Pennsylvania Bureau of Motor Vehicles) clearance letter. This letter acts as proof that a driver has resolved outstanding issues, such as unpaid fines or other legal complications. Similar to the DL-16LC, the clearance letter requires submission to the Bureau of Motor Vehicles and confirms the individual’s eligibility to regain their driving privileges. Both documents hinge on clear communication with DMV authorities about the driver's status and must be handled promptly to avoid further legal repercussions.

The Notice of Suspension is another form that parallels the DL-16LC. It serves as official notification from the DMV regarding a driver’s suspended status, detailing reasons for the suspension and the corresponding timeline. Like the DL-16LC, this notice prompts the driver to take action regarding their eligibility and rights. Receiving this notice can trigger a series of steps, including filing forms like the DL-16LC, as drivers often need to provide documentation for reinstatement after a suspension.

The Financial Responsibility Certificate is also similar to the DL-16LC. It indicates that a driver has insurance coverage, which is crucial for reinstatement of driving privileges following a suspension. Both documents highlight the intersection of driving safety and legal compliance, ensuring that only those with valid insurance can regain their licenses. While the DL-16LC focuses on acknowledging the suspension and seeking credit, the Financial Responsibility Certificate emphasizes proof of financial responsibility on the driver's part.

The Request for Hearing form shares characteristics with the DL-16LC in that it is a formal application made to contest a driver's suspension. Both documents involve significant interaction with the DMV and often demand detailed personal and incident-related information. The purpose of the Request for Hearing is to appeal against the suspension, while the DL-16LC acknowledges acceptance of the suspension and seeks options for reinstatement, creating a clear procedural path for drivers to understand their rights and responsibilities.

The Traffic Violation Notice (TVN) is another document similar to the DL-16LC, as it notifies a driver of violations that may lead to suspension. Both require careful attention to detail, as errors in either can result in further complications. While the TVN focuses on the violation itself, the DL-16LC addresses the aftermath, emphasizing the importance of understanding the consequences of traffic infractions. Each document aligns with maintaining accountability within the driving community.

The Application for Reinstatement is closely related to the DL-16LC. This document is submitted after completing the suspension period and is essential for regaining a driver's license. Just like the DL-16LC, it requires specific information to confirm eligibility for reinstatement. The forms collectively facilitate a smooth transition back to lawful driving, emphasizing the importance of following procedural guidelines set by the DMV to avoid delays.

Lastly, the Driver Improvement Program (DIP) Enrollment Form is akin to the DL-16LC for those who must complete a course due to violations. Both documents illustrate a proactive approach to remedying driving-related issues and restoring privileges. When a driver enrolls in a DIP, completion often becomes a condition for reinstatement, creating a direct link with the acknowledgment embedded in the DL-16LC, where individuals must commit to rectifying their driving behaviors.

Dos and Don'ts

Filling out the DL-16LC form accurately is critical to ensure that you receive the appropriate credit for your driving suspension, revocation, disqualification, or cancellation. Here are some important do's and don'ts to keep in mind:

  • Do print the form neatly using blue or black ink.
  • Do complete all sections of the form as required.
  • Do ensure you include your signature and date at the end of the form.
  • Do surrender any valid Pennsylvania driver’s license, permit, or camera card you may have.
  • Do double-check your information for accuracy before submitting.
  • Don't leave any sections blank; all information must be provided.
  • Don't use a post office box as your only address; include your actual residence address.
  • Don't forget to mark all relevant boxes regarding your license status.
  • Don't submit the form without a copy for your records.

Being thorough and accurate can help avoid delays and ensure a smoother process. If you have any concerns or questions while filling out the form, don’t hesitate to reach out to the appropriate contacts for assistance.

Misconceptions

The DL-16LC form can be a bit confusing, and there are several misconceptions surrounding its purpose and use. Here’s a look at eight common misunderstandings:

  • It can be used for any driver's license issue. Many believe the DL-16LC can address all licensing problems. However, it's specifically for suspensions, revocations, disqualifications, or cancellations as indicated in Section B.
  • You don’t need to surrender a valid license to receive credit. However, if you have a valid Pennsylvania driver's license, permit, or camera card, you must surrender it to earn suspension credit.
  • Providing incorrect information is harmless. In fact, providing false information can lead to serious consequences, including fines or even imprisonment.
  • A post office box is sufficient for your address. While a P.O. Box can be included, it cannot be your only address. You must also provide your actual residence address.
  • There's no need to notify your voter registration office. If you change your address and are a registered voter in Pennsylvania, you should check the box to notify the county voter registration office.
  • All sections of the form are optional. It’s crucial to complete all pertinent sections. If sections A, B, and C are not filled out completely, credit may not be granted.
  • You can simply call to process your request. This form must be mailed to the Bureau of Driver Licensing in Harrisburg, PA. It can’t be processed over the phone.
  • If I don’t receive a receipt, my application was unsuccessful. Not receiving a receipt within three weeks doesn’t mean your application was denied. It’s important to verify the status by contacting PennDOT.

Understanding these misconceptions can help smooth the process of handling driver licensing issues. Always refer directly to resources for the most accurate information regarding the DL-16LC form.

Key takeaways

  • All information must be completed clearly in blue or black ink.
  • The form is for individuals whose driving privileges are suspended, revoked, disqualified, or canceled.
  • You must surrender any valid license, permit, or camera card to receive credit for your suspension.
  • Important sections to fill out include your name, birth date, and address. Be sure to include your phone number and email if applicable.
  • A post office box may be used with your actual residence address, but cannot be the only address listed.
  • Indicate if you are a registered voter and if you want the county office notified of any changes.
  • Always sign and date the form. Without this, credit will not be approved.
  • Once the form is mailed, PennDOT will send a receipt to confirm the start date of your credit.
  • If you don’t receive this receipt within three weeks, it’s important to contact PennDOT to verify your request.