DMV ADMINISTRATOR PETITION – UNAVAILABLE DOCUMENTATION
Wisconsin Department of Transportation
MV3012 6/2021
Use of this form is authorized, pursuant to Wisconsin Administrative Code § Trans 102.15(5m), for a photo identification
card for voting purposes that complies with 2011 Wisconsin Act 23, s. 343.50(5)(a)3., and any other applicable
requirements.
“Unavailable” may include items that persons have forgotten to bring with them when applying for an identification card.
This process is available for applicants unable to provide proof of name and date of birth or United States citizenship.
A. To facilitate the document search process for United States-born citizens, please provide the following:
Please be advised that complete birth record information improves the search process with Vital Records.
Birth Name – First Middle Last (as it appears on the birth certificate)
Sex Birth Date (mm/dd/yyyy) Place of Birth (State/Jurisdiction/Territory)
Male Female
Place of Birth – County or Equivalent (Parish – LA, Borough – AK) Place of Birth (City, Village or Township)
Parent’s Birth Name – First Middle Last (as it appears on the birth certificate/Maiden name – if applicable)
Parent’s Birth Name – First Middle Last (as it appears on the birth certificate/Maiden name – if applicable)
Is your current name different than that on your birth record
Yes No If Yes, What is Your Current Legal Name:
B. For United States citizens, not born in the United States, who do not have the appropriate documents
available, please provide the following United States Customs and Immigration Service (USCIS) identifiers. This
information will be used to verify citizenship status with the Department of Homeland Security.
Alien/USCIS Number Citizenship Certificate Number
C. All Applicants: Contact Information
Email Address (Area Code) Telephone Number
Wisconsin DMV or Vital Records may contact you for any follow-up information which may be necessary to complete the verification process.
The information that I have provided on this petition application is true under penalty of perjury and I am a resident of
Wisconsin. (s. 343.14(5) Wis. Stats.)
X
(Signature of Applicant) (Date Signed – m/d/yyyy)
— DMV Office Use Only —
Envelope Number DID Photo Number
— DHS Use Only —
Vital Records Search Date (m/d/yyyy) Processor ID
Verified Not Verified