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2. First Name*
3. Last Name*
5. Email*
6. Sheriff ID Number
8. Mailing Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number*
16. This request is for:

    1. ID Card
    2. CCW Renewal
    3. HR218 Renewal
    4. DMV Confidentiality
18. My ID Card was:

    1. Lost
    2. Stolen
19. I would like my CCW Renewal by:

    1. Mail
    2. Email
    3. Fax
20. I would like my DMV Confidentiality by:

    1. Mail
    2. Pick-up
21. If you are reporting a lost or stolen ID card, you must also provide a police file number.
23. If you are requesting the renewal application be faxed to you, please provide a fax number:
25. Additional Instructions
27. Please let us know if you are aware of the death or serious illness of any retirees.
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

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