STATE OF CONNECTICUT

DEPARTMENT OF MOTOR VEHICLES

[Link]/dmv We'd like to hear from you!

Date: 4/15/2026 CONGRATULATIONS

SAMUEL BURLACHENKO
YOU HAVE SUCCESSFULLY SCHEDULED YOUR LEARNER PERMIT VISION AND KNOWLEDGE TEST APPOINTMENT
ALL DOCUMENTS PRESENTED TO THE DMV MUST BE ORIGINAL OR CERTIFIED COPIES.
PHOTOCOPIES WILL NOT BE ACCEPTED.

BE PREPARED. Bring the following REQUIRED documents with you!

Please refer to the document checklist on page 3 or at [Link]/dmv/RealID for a complete list of acceptable documents to
answer 1-5 below.
1. IDENTITY: You must present two forms of identification. At least one of the documents must be from the primary document list.
My primary document I will present is: , my 2nd is

2. SOCIAL SECURITY NUMBER: By law, you must provide your Social Security number, which must be verified with the Social
Security Administration. Non-US Citizens who are not eligible for a Social Security number must present an ineligibility letter from the
Social Security Administration.

3. CONNECTICUT RESIDENCY: You must present two different pieces of mail from two different sources showing your name and
Connecticut residence address, dated within 90 days unless stated otherwise on document checklist.
My 1st proof of residency I will present is: , my 2nd is
4. LEGAL PRESENCE IN THE UNITED STATES: Non U.S Citizens only.

Legal Status will be verified using Systematic Alien Verification of Eligibility (SAVE) which will take ten (10) business days or more.

5. NAME CHANGE DOCUMENTS, if applicable: If there have been multiple name changes, you must provide documentation to
prove the continuity of the names.
My name change document(s) I will present is(are):

6. Current non-driver ID, if issued, which must be surrendered. Visit our website at [Link]/dmv/exchange to verify if you qualify for an
Exchange.
7. A printout of this appointment confirmation page.

8. The completed R229 application, page 2.

Bring your glasses or contact lenses, if needed, for testing. If you fail the vision test you will not be able to proceed to the
knowledge test and will be required to reschedule.
If under 18, parent or legal guardian must accompany you with their identification to sign the parental consent
(Legal guardian must present certificate of legal guardianship from the court).
If parent or legal guardian is unable to come with you, you must present a notarized certificate of parental consent form (Form
2-D).This form can be found on our website [Link]
Study the Connecticut Driver's Manual You will be required to reschedule, wait seven days and repay the test fee if you fail the test.
Effective January 1, 2026, a new CT Law requiring new drivers to complete an online “Connecticut Work Zone Safety Course”.

If you fail to comply with the above requirements you will not be allowed to test and must reschedule your appointment.

If you fail to appear at your scheduled time you will be required to reschedule and repay the test fee.
If you are unable to keep this appointment and reschedule within two days of your appointment date you will be required to repay
the test fee. If you cancel within two days of your appointment date you will not be eligible for a refund of the test fee.

APPOINTMENT DETAILS
PIN: S2DDHSRG Fee Paid: Learner Permit $19.00
Date/Day/Time: 4/24/2026 Friday 8:00 AM Test Fee $40.00
Testing Location: Total
4 Pearson Way, Enfield, CT, 06082 $59.00
Authorization Code: 832220 Payment Date: 4/15/2026
PIN: S2DDHSRG 4/24/2026 Friday 8:00 AM 4 Pearson Way, Enfield, CT, 06082 $59.00
DMV USE OUT OF STATE DRIVE ADD/REMOVE
NEW TRANSFER ONLY ENDORSEMENT/RESTRICTION EXCHANGE RETEST
ONLY

APPLICATION FOR A NON-COMMERCIAL

LEARNER PERMIT AND/OR DRIVER LICENSE STATE OF CONNECTICUT
R-229 REV. 7-2023 DEPARTMENT OF MOTOR VEHICLES
On The Web At [Link]/dmv
INSTRUCTIONS: Complete 1-18, then present
1. Required Identification Documents & Proof of Connecticut
Residency: see "Acceptable Forms of ID" at [Link]/dmv
2. 16 and 17 year olds: Certificate of Parental Consent Form 2D
NO FEE LEARNER PERMIT NUMBER DATE OF ISSUE
(if not accompanied by authorized individual)
3. Applicable Fees US MILITARY

1. APPLICANT'S NAME (Last, First, Middle, Suffix) 2. GENDER 3. DATE OF BIRTH 4. HEIGHT 5. COLOR OF EYES
BURLACHENKO, SAMUEL M F X 12/21/2008 ft. in.
6. MAILING ADDRESS (No., Street, City or Town, State, Zip Code) 7. RESIDENCE ADDRESS (If different from mailing address)
567 BOSTON NECK RD, SUFFIELD, CT, 06078
8. US CITIZEN? If "NO", list ALIEN REGISTRATION NO. 9. CONNECTICUT 10. DO YOU WANT TO BE IN THE ORGAN/TISSUE DONOR 11. DAYTIME PHONE NO.
RESIDENT? REGISTRY? If yes, you are agreeing to be a donor
Yes No Yes No Yes No
and the designation will be on your
license. ( ) 413 519-0392
12. SOCIAL SECURITY NUMBER 13. LIST ANY OTHER NAMES EVER USED (Alias, Maiden, etc) 14. E-MAIL ADDRESS
JERUSALEMLANA@[Link]
QUESTIONS YES ( ) NO ( )

15. Have you previously failed a driver's license FAILED LOCATION DATE
examination in Connecticut? VISION KNOWLEDGE ROAD

16. Do you now, or have you ever held a Connecticut Learner Permit, PERMIT, LICENSE OR ID NO. (9 digits) EXPIRATION DATE NO. OF YEARS
License or Non-Driver Identification Card?

17. Do you now, or have you ever held an Operator's License or STATE DRIVER LICENSE OR ID. NO. EXPIRATION DATE NO. OF YEARS
Identification Card from another state?
IN WHAT STATE(S)?
18. Is your privilege to operate a motor vehicle suspended or subject to
suspension in Connecticut or in any other state?
Section 14-36l of the Connecticut General Statutes requires the Commissioner to transmit my
SELECTIVE information to the Selective Service System. By signing and submitting this application, I consent I hereby certify that I do not
to be registered with the Selective Service System, provided I am at least age 16 but under age MEDICAL have any health or vision
SERVICE 26 and meet the criteria for registration in accordance with the Military Selective Service Act. If I problems or conditions that
CERTIFICATION
CONSENT am under age 18, I understand that my information will be transmitted to Selective Service but I prevent me from driving safely.
will not be registered until I reach age 18.
The information provided to the Commissioner of Motor Vehicles herein is SIGNATURE OF APPLICANT DATE SIGNED
subscribed by me, under penalty of false statement, in accordance with
CERTIFICATION the provisions of Section 14-110 and 53a-157b of the Connecticut General
BY APPLICANT Statutes. I understand that if I make a statement which I do not believe to
be true, with the intent to mislead the Commissioner, I will be subject to
prosecution under the above-cited laws. X
DO NOT WRITE BELOW THIS LINE - OFFICE USE ONLY
PROOF OF TYPE OF IDENTIFICATION SHOWN EXAMINERS INITIALS STAMP NO.
I.D. SCANNED FIRST VISIT
IDENTIFICATION
FULL LEGAL If different than entered in name section above (# 1)

NAME
PARENTAL I hereby request that a learner's permit RELATIONSHIP TO MINOR SIGNED (Authorized Consenter) CONSENTER'S LIC. NO. OR OTHER I.D.
CONSENT and/or license be issued to the minor
AGE 16 OR 17 ONLY filing this application. X
VISION VISUAL AID USED RESULTS AGENTS INITIALS PUNCH NO. AND PUNCH
SCREENING NONE GLASSES/CONTACTS PASSED FAILED
RESULTS
KNOWLEDGE TEST RESULTS APPLICANTS INITIALS CONFIRMING IDENTIFICATION
DOCUMENTS RETURNED
TEST COMPUTER/AUDIO WRITTEN WAIVED PASSED FAILED
ISSUE PERMIT WITH CORRECTIVE ISSUE DRIVE ONLY
PERMIT ISSUE LEARNER PERMIT ISSUE MOTORCYCLE PERMIT LENSES (B-RESTRICTION) (Y-RESTRICTION)
AGENT I hereby certify that I have examined the applicant's identity SIGNED (Agent) PUNCH NO. AND PUNCH DATE SIGNED
documents and the test results stated herein are true and
CERTIFICATION correct. X
CLASSROOM SCHOOL NAME COMMERCIAL SCHOOL LICENSE NO. DRIVER EDUCATION CERTIFICATE NO.

DRIVER INSTRUCTION
TRAINING PRACTICE SCHOOL NAME (If same as above print "same") COMMERCIAL SCHOOL LICENSE NO. DRIVER EDUCATION CERTIFICATE NO.
DRIVING
I hereby subscribe and certify under penalty of false statement, in accordance with the provisions of Section 14-110 and 53a-157b of the Connecticut General Statutes that I
understand that if I make a statement, which I do not believe to be true, with the intent to mislead the Commissioner I will be subject to prosecution under the above-cited laws, that,
HOME I am qualified under Section 14-36, of the Connecticut General Statutes, over 20 years of age, have no suspensions within the previous 4 years and the Applicant has received the
required training, including the equivalent of 22 hours classroom training; 40 hours on-the-road instruction; the 8 hours Safe Driver course, including a 2 hour Parent Training, as
TRAINING/ supported by a parent log and/or driving school certificate.
COMMERCIAL 1 2 3 SIGNATURE OF INSTRUCTOR (Home Training/Commercial) OPERATOR LICENSE NUMBER OR
SCHOOL LICENSE NUMBER
TRAINING Home Training Comm/Sec and Home Comm/Sec Only
22 hr class equiv 30 hrs class/minimum 30 hrs class
CERTIFICATION 40 hr on-the-road 8 hr safe driving plus home 40 hrs on-the-road
8 hr safe driving training 40 hrs on-the-road X
SPECIAL EQUIPMENT
ROAD TEST WAIVED PASSED FAILED
AND LICENSE NON-COMMERCIAL CLASS ENDORSEMENT RESTRICTIONS (Circle All Applicable)
INFORMATION
D M Q 3 B C D E F G R U Y
AGENT I hereby certify that I have verified the applicant's SIGNED (Agent) PUNCH NO. AND PUNCH DATE SIGNED
identity and the test results stated herein are true
CERTIFICATION and correct. X
REAL ID DOCUMENT IDENTITY VERIFICATION CHECKLIST
To obtain a new learner’s permit, driver’s license or identity (ID) card, or to obtain a verified REAL ID driver’s license or ID card, you will need
to provide valid/unexpired, original documents, or certified copies. Out of state learner’s permits are not transferable.

Photocopies, notarized photocopies, non-certified copies of forms that require certification, and damaged or mutilated documents are not
acceptable. DMV will scan and store images of all original documents.

Two (2) forms of the same identification will not be accepted. If any document presented is in a language other than English, it must be
translated by a DMV approved translator.

You must satisfy sections A , B , C and if applicable, D and E .

A 2 IDENTITY DOCUMENTS: SECONDARY document list

You must present two (2) forms of identification; at least £ Social Security Card (Not laminated or metal. Sixteen (16) and
one of the documents must be from the Primary document older must sign)
list. £ Connecticut issued driver’s license, learner’s permit, or ID card
(You may be required to surrender your driver’s license or
PRIMARY document list ID card)
U.S. born £ Out of State U.S., U.S. Territory, or Canadian photo driver’s
£ U.S. or U.S. Territory Birth Certificate or Registration of Birth license, photo learner’s permit or photo ID card (You may be
(Hospital issued and Puerto Rico issued prior to July 1, 2010 required to surrender your driver’s license or ID card)
not acceptable; foreign place of birth see Non-U.S. Born) £ Certified school transcript (School photo ID is not acceptable)
£ U.S. Passport or Passport Card £ Marriage or Civil Union Certificate (certified copy issued by
Non-U.S. born town/city)
£ U.S. Passport or Passport Card £ Court Order: Must contain full name and date of birth (i.e. name
£ Foreign Passport w/ supporting documents (See Section D change, adoption, marriage or civil union dissolution). Does not
below)* include abstract of criminal or civil conviction
£ Certificate of Naturalization (N-550 or N-570)* £ Connecticut Pistol or Revolver Permit
£ Certificate of Citizenship (N-560 or N-561)* £ U.S. Military ID or dependent card with photo
£ Permanent Resident Card (I-551)* £ Military discharge/separation papers (DD-214)
£ U.S. Consular Report of Birth Abroad (FS-240, DS-1350 £ State or Federal Employee Identification with signature and photo
or FS-545) and/or physical description with or without date of birth
£ Employment Authorization Document (I-766)* £ CT Department of Correction certificate CN101503 (which is only
issued prior to release)
FULL LEGAL NAME £ Pilot’s license (issued by the U.S. DOT Federal Aviation
By law, the full name shown on the Primary document is Administration)
your legal name and will be printed on your card. If your £ Veteran Health Identification Card (VHIC)
name is different than the Primary document, see Section E £ Federally Recognized Tribal Member ID card
below. £ DHS Trusted Traveler Cards (Global Entry, NEXUS, SENTRI,
* Subject to Systematic Alien Verification of Eligibility (SAVE) FAST)
(See Section D below) £ Transportation Worker Identification Credential (TWIC)
£ Federal Bureau of Prisons Identification Card

B SOCIAL SECURITY NUMBER:

By law, you must provide your Social Security number, which Non-U.S. Citizens who are not eligible for a Social Security
must be verified with the Social Security Administration (SSA). number must present an ineligibility letter from the SSA.

C 2 FORMS OF PROOF OF CONNECTICUT RESIDENCY:

You must provide two (2) different forms of documentation from £ Bank statement showing the bank’s name and mailing address
the list below to prove Connecticut residency. £ Pre-printed pay stub showing your employer’s name and address
£ Property or excise tax bill dated within the previous twelve
These documents must be from two (2) different sources and (12)months
MUST: £ Valid unexpired CT driver’s license, learner’s permit or ID card
with the same address
• Show your name and your Connecticut residence address £ Current valid homeowner’s, renter’s policy or motor vehicle
• Be dated within ninety (90) days (unless stated otherwise insurance card or policy dated within the previous 12 months
below) £ Current valid Connecticut motor vehicle registration
• Be computer generated (typed) £ Current motor vehicle loan statement for a motor vehicle
• Be a hard copy registered in your name
NOTE: The parent(s) or legal guardian(s) residing at the same £ Residential mortgage, lease or rental contract showing
address of a minor may provide any two (2) of the acceptable signatures from all parties needed to execute the agreement and
documents, addressed to the parent(s) or legal guardian(s), to dated within the previous twelve (12) months
prove the minor’s residency. £ Change-of-address confirmation from the United States Postal
Service showing your prior and current address (Form CNL107)
Acceptable Documents £ Official school records showing enrollment
£ Postmarked mail (address may be handwritten) £ Report card
£ Bill from a bank or mortgage company, utility company, credit
card company, doctor or hospital

D LEGAL PRESENCE IN THE UNITED STATES (Non-U.S. • Only U.S. Citizens and Permanent Residents are eligible for a
born): verified REAL ID driver’s license or ID card. If you are not a U.S.
Citizen or Permanent Resident, you may be eligible for a Limited
Legal status will be verified using Systematic Alien Term verified REAL ID. Please see [Link]/dmv for more
Verification of Eligibility (SAVE) which may take ten (10) information.
business days or more.
• If you are not eligible for a verified REAL ID driver’s license or ID
£ U.S. Passport or Passport Card card, you will be issued a non-verified (Not for Federal
£ I-94 Identification) driver’s license or ID card.
£ I-551 stamp in foreign passport
£ Permanent Resident Card or Resident Alien Card • Non-U.S. Citizens who are not eligible for a Social Security
£ Employment Authorization Document (I-766) number must present an ineligibility letter from the SSA but may
£ Refugee Travel Document not qualify for a verified REAL ID driver’s license or ID card.
£ F1 requires I-20 and I-94
£ J1 requires DS2019 and I-94 • An individual with B1/B2, waiver-tourist (WT), or waiver-business
(WB) visitor status is NOT eligible to obtain a CT driver’s license
or ID card.

E NAME CHANGE DOCUMENTS (if applicable): If there have been multiple name changes, you must provide
£ Marriage or civil union certificate (certified copy issued by documentation to prove the continuity of the names.
town/city)
£ Marriage or civil union dissolution NOTE: Your new name must match the name that is on file with the
£ Probate court name change document SSA. Visit the SSA first to change your name. Allow at least
£ DHS Petition for Name Change (USCIS Form N-662) forty-eight (48) hours for SSA to update its system.

Questions regarding acceptable documentation can be directed to our Contact Center at 860-263-5700
or visit [Link]/dmv.
DI-3 REV. 10-2025
LISTA DE DOCUMENTOS DE VERIFICACIÓN PARA EL REAL ID
Para obtener un nuevo permiso de aprendiz, licencia de manejar o tarjeta de identidad (ID) o para obtener una licencia de manejar verificada o tarjeta de
identidad verificada REAL ID, necesitará proporcionar copias originales o certificadas, válidas y vigentes. Los permisos de aprendiz de otros estados no son
trasferibles
No se aceptan fotocopias, fotocopias notarizadas, copias de formularios que requieren una certificación sin estar certificadas y documentos dañados o
mutilados. El DMV escaneará y archivará imágenes de los documentos originales.
No se aceptan dos (2) formas idénticas de identificación. Si se presenta cualquier documento en un idioma que no sea inglés, habrá de ser traducido por un
traductor aprobado por el DMV.
Debe satisfacer las secciones A , B , C , y de corresponder la D y E .

A 2 DOCUMENTOS DE IDENTIDAD: Lista de documentos SECUNDARIOS

Debe presentar dos (2) formas de identificación: por lo menos £ Tarjeta del Seguro Social (sin laminar ni en metal. Aquellas personas
una de ellas debe ser de la lista de documentos primarios. mayores de diez y seis (16) años la deben firmar)
£ Licencia de manejar, permiso de aprendiz o tarjeta de identidad
Lista de documentos PRIMARIOS emitida por el estado de Connecticut (puede que tenga que entregar
Para aquellas personas nacidas en EE. UU. su licencia de manejar o tarjeta de identidad)
£ Certificado de nacimiento estadounidense o de un territorio £ Licencia de manejar, permiso de aprendiz, o tarjeta de identidad con
estadounidense o inscripción de nacimiento. (aquellos foto emitida por otro estado estadounidense, territorio
emitidos por un hospital o Puerto Rico antes del 1 de julio estadounidense o Canadá (puede que tenga que entregar su licencia
de 2010 no serán admisibles. Para aquellas personas nacidas de manejar o tarjeta de identidad)
fuera de EE. UU. vean la sección Para aquellas personas £ Expediente académico certificado (no se aceptan las tarjetas de
no nacidas en EE. UU.) identidad escolares con foto)
£ Pasaporte o tarjeta pasaporte estadounidense £ Certificado de matrimonio o unión civil (copia certificado por el
Para aquellas personas no nacidas en EE. UU. pueblo/municipalidad emisor)
£ Pasaporte o tarjeta pasaporte estadounidense £ Orden judicial, debe constar su nombre completo y fecha de
£ Pasaporte extranjero con documentos de apoyo (vea la sección nacimiento (por ejemplo: cambio de nombre, adopción, disolución
D a continuación) * de un matrimonio o unión civil). No se admiten abstractos de una
£ Certificado de naturalización (N-550 o N-570) * condena penal o civil.
£ Certificado de ciudadanía (N-560 o N-561) * £ Permiso de portar una pistola o un revolver de Connecticut
£ Tarjeta de residente permanente (I-551) * £ Tarjeta de identidad de las fuerzas armadas o tarjeta de dependiente
£ Certificado consular estadounidense de un nacimiento en el con fotografía
extranjero (FS-240, DS-1350 o FS-545) * £ Órdenes de alta/ separación de las fuerzas armadas (DD-214)
£ Permiso de trabajo (I-766) * £ Tarjeta de identidad de empleado estatal o federal con la firma y
fotografía y/o una descripción física con o sin la fecha de nacimiento
NOMBRE LEGAL COMPLETO £ Certificado del Departamento de Correcciones del estado de
Por ley, el nombre completo que aparece en el documento Connecticut CN101503 (únicamente emitido antes de ser puesto bajo
PRIMARIO es su nombre legal y se imprimirá en su tarjeta. Si su libertad)
nombre es diferente al que consta en el documento PRIMARIO, £ Licencia de piloto (emitida por la Administración Federal de Aviación
vea la sección E a continuación. del Departamento de Transporte del EE. UU.)
£ Tarjeta de identidad sanitaria de veterano (VHIC)
*Sujeto a la verificación sistemática de extranjeros (SAVE) (vea la £ Tarjeta de identidad de una tribu reconocida por el gobierno federal
sección D a continuación) £ Tarjeta de viajero confiable del DHS (Global Entry, NEXUS, SENTRI,
FAST)
£ Credenciales de identidad de los trabajadores de transporte (TWIC)
£ Tarjeta de identidad de la Administración Federal de Prisiones

B NÚMERO DEL SEGURO SOCIAL:

Por ley, debe proporcionar su número del Seguro Social que debe ser Los no-ciudadanos estadounidenses quienes no califican para un número
verificado con la Administración del Seguro Social. del Seguro Social deben presentar una carta de que no califican de la
Administración del Seguro Social.

C 2 COMPROBANTES DE RESIDENCIA EN CONNECTICUT:

Debe presentar dos (2) documentos diferentes de la lista a £ Extracto de una cuenta bancaria en la que consta el nombre y
continuación para comprobar que es residente de Connecticut. dirección del banco
£ Talón de pago pre-imprimido en el que consta el nombre y la dirección
Estos documentos deben ser de 2 entidades diferentes y DEBEN: del empleador
£ Factura de los impuestos de la propiedad o especiales fechada en los
• Mostrar su nombre y dirección en Connecticut últimos doce (12) meses
• Estar fechados en los últimos noventa (90) días (excepto si se £ Licencia de manejar, permiso de aprendiz o tarjeta de identidad válida y
indica lo contrario a continuación) vigente emitida por Connecticut con la misma dirección
• Haber sido generados por una computadora (impreso) £ Póliza vigente del seguro de la propiedad, alquiler o vehículo, tarjeta del
• Estar impresos seguro o copia de la l fechada en los últimos doce (12) meses
£ Matrícula vehicular vigente de Connecticut
NOTA: Lo(s) padre(s) o tutor(es) legal(es) que residen en la misma
£ Extracto de cuenta de un préstamo vehicular para un vehículo
dirección que un menor pueden presentar dos (2) de los siguientes
matriculado a su nombre
documentos admisibles, dirigidos a los padres(s) tutor(es) legal(es)
£ Contrato hipotecario o de alquiler con las firmas de las partes
para comprobar la residencia del menor. autorizadas de ejecutar dicho contrato fechado en los últimos doce (12)
Documentos aceptables meses
£ Sobre con matasellos (la dirección puede estar escrita a mano) £ Confirmación de cambio de dirección emitido por Correos de Estados
£ Factura de un banco o hipotecaria, servicios públicos, tarjeta de Unidos en el que consta la dirección anterior y la actual (formulario
CNL-107)
crédito, médico u hospital
£ Expediente escolar oficial, comprobando la matricula actual
£ Notas escolares

D PRESENCIA LEGAL EN LOS ESTADOS UNIDOS (no nacidos en • Solo los ciudadanos estadounidenses y residentes permanentes
Estados Unidos): califican para una licencia de manejar o tarjeta de identidad verificada
REAL ID. De lo contrario puede que califique para una REAL ID
Su condición migratoria se verificará utilizando el Systematic verificada de vigencia limitada. Para más información consulte el:
Alien Verification of Eligibility (SAVE) [verificación sistemática de [Link]/dmv
extranjeros]. Lo cual podrá tardar hasta diez (10) días laborales o
más • Si no califica para una licencia de manejar o tarjeta de identidad
verificada REAL ID, se le emitirá una licencia de manejar o tarjeta de
£ Pasaporte o tarjeta pasaporte estadounidense identidad no verificada (no para fines de identificación federales)
£ I-94
£ Sello I-551 en un pasaporte extranjero • Los no-ciudadanos estadounidenses que no califican para obtener
£ Tarjeta de residente permanente o de extranjero residente un número del Seguro Social deben presentar una carta de la
£ Permiso de trabajo (I-766) Administración del Seguro Social indicando que no califican y puede
£ Documento de viaje para refugiados que no califiquen para una licencia de manejar o tarjeta de identidad
£ El F1 requiere el I-20 y I-94 verificada REAL ID
£ El J1 requiere DS2019 y I-94
• Un individuo portador de un visado B1/B2, exención por turismo (WT)
o exención por negocios (WB) NO califica para obtener una licencia de
manejar o tarjeta de identidad de Connecticut.

E DOCUMENTOS POR UN CAMBIO DE NOMBRE (si corresponde) Si ha habido varios cambios de nombres, debe proporcionar
£ Certificado de matrimonio o unión civil (copia certificada emitida por documentación para comprobar la continuidad de los nombres.
el municipio/ pueblo emisor)
£ Disolución de matrimonio o unión civil NOTA: Su nuevo nombre debe ser igual a aquel registrado con la
£ Documento de cambio de nombre del tribunal sucesorio Administración del Seguro Social (SSA). Visite el SSA primero para
£ Petición al DHS para un cambio de nombre (USCIS formulario cambiar su nombre. Debe dejar pasar por lo menos cuarenta y ocho (48)
N-662) horas para que la SSA actualice su sistema.

Para preguntas sobre qué documentos son admisibles, pueden comunicarse con el centro de comunicación
del DMV en el 860-263-5700 o visite [Link]/dmv.
DI-3 REV. 10-2025