MVD Forms Library

D.O.T. Medical Examination Report

Medical Examination Report (MER) Form (MCSA–5875)

De-Insured Certificate

For an insurance requirements exemption, if you wish to maintain the current registration on a vehicle that you own or lease, but it is temporarily not being used.

Dealer Acquisition Contract

To allow a customer to transfer their vehicle to a licensed motor vehicle dealer when the certificate of title is in the possession of the lienholder.

Dealer Licensing Record Inquiry

To request information from the licensing record of an authorized motor vehicle dealer.

Dealer Plate Audit Record

To record plate and vehicle information for an MVD audit of an automobile dealership.

Dealer Record Amendment

For a motor vehicle dealer, broker, recycler or sales finance company to report information that has changed since their license application, or to add a branch location.

Dealership Administrator Application

Authorization to add, edit or deactivate other Dealership Representatives

Diesel Differential & Dyed Diesel Adjustment

To apply for a credit of use fuel tax paid on fuel ultimately sold to light class motor vehicles or exempt vehicles, and for adjustment for dyed diesel sales.

Diesel Inventory Reconciliation

Diesel Inventory Reconciliation

Disability-Hearing Impaired Plate/Placard App. Individual

To apply for a disability plate or placard (both permanent and temporary), to add a disability symbol to a special license plate, or for a hearing impaired license plate or placard.

Dismantle Request

For an Arizona licensed automotive recycler to request authorization to dismantle vehicles in their possession.

Driver Behavior Report - Law Enforcement/MVD Use Only

For law enforcement and MVD agents to submit observations to the MVD Medical Review Program that indicate the possible need for a driver to re-examined.

Driver Condition/Behavior Report

For any person to report information and observations regarding a licensed driver's physical or mental/emotional condition that may affect his or her ability to safely operate a motor vehicle.

Driver Lic. Manual/Customer Service Guide-Spanish

Spanish translation to the Driver License Manual/Customer Service Guide, 99-0117.

Driver License and Vehicle Complaint

To report the nature of a complaint for investigation by the OIG Fraud Unit.

Driver License Examination Monthly Scoresheet Log

For an authorized Third Party to report to MVD the examination scoresheets completed for each month.

Driver License Manual/Customer Service Guide

To provide information on applying for a driver license and the rules of the roads needed to receive a driver license, also general information regarding MVD services and applying for a title and registration.

Driver License Name Change

Driver License Name Change

Driver License On-the-Job Training Agreement

Driver License On-the-Job Training Agreement

Driver License/ID Cancellation Request

For the licensee or a parent or other legal guardian (if the license holder is a minor) to request the cancellation of the driver license or identification card.