Mississippi Administrative Code › Title 31 - Public Safety › Part 1 - DRIVER SERVICES ADMINISTRATIVE CODE › Chapter 2 - Obtaining Temporary Permits › Rule 31-1-2.6 - Instructions for Completing the Application for Mississippi Driver License or Temporary Permit - Form DL-4

Current through June 25, 2024
1. Full Name - Full
				name must be typed or printed in (preferably black) ink. Do not use nicknames,
				etc. The full name appearing on the legal birth certificates (except married
				women) must be used. If a female student is married, place the maiden name in
				proper space. She must provide original marriage license.
2. Social Security Number - The Department of
				Public Safety requires that each applicant insert his/her Social Security
				Number in the proper space. The Social Security Number is used as the driver
				license number. Many students do not have Social Security Numbers. Driver
				education teachers may obtain the number of applications needed from local
				Social Security districts or branches or:
Social Security Administration
Post Office Box 2249
Jackson, MS 39205
Telephone: 601-960-5001
The test will not be administered unless the Social Security
				  card is presented. When students complete the driver education course and apply
				  to the Mississippi Highway Patrol to take the road test, they must have a DL-4
				  application and temporary permit. Helping students now to obtain the same will
				  greatly help the Mississippi Highway Patrol administer the driver license
				  program.
3. Mailing
				address, Number and Street - Complete address must be given. Example: 938 South
				State Street, Jackson, MS 39201. (Number, street, city, state and zip code). If
				home address is the same as mailing address, write the word the same in that
				place.
4. Race - Use the following
				abbreviations:
W- White B- Black Y- Oriental I- Indian O- Other
5. Hair - Natural color of hair
				must be given.
6. Questions -
				Applicants must answer all questions. If the answer is yes, be sure the
				applicant fully explains each yes answer.
7. Signature of Applicant - Original
				signature (usual signature of applicant) must be used.
8. Signature(s) of Parent, Guardian, or
				Responsible Person(s) - The person(s) signing the responsible affidavit must
				appear before a notary public and sign their usual signature. This must be
				signed in ink. Listed below are the regulations applicable to signatures.
a. One parent Deceased- Write word DECEASED
				on appropriate line; only one (1) signature is required.
b. Parents Legally Divorced- Write words
				DIVORCED on appropriate line; only one (1) signature is required.
d. Parents Legally Separated- Write words
				LEGALLY SEPARATED on appropriate line; only one (1) signature is
				required.
e. Parents NOT Legally
				Separated- Both parents must sign the responsibility affidavit, this may be
				handled in different ways:
i. Both parents, at
				different times or together, may appear before a notary public and place their
				signature on the same application card.
ii. If parents are separated by distance, one
				in Jackson, one in another city or state, mail the application to the parent
				not at home with a note requesting the form be notarized and mailed back to the
				home address.
iii. Formal power of
				attorney documents must be presented.