West Virginia Division of Motor Vehicles · West Virginia state form
DMV-12-IND Non-West Virginia Residency Statement
Use this statement to attest to residency, employment, military duty station, or student status related to fulfilling DUI Safety and Treatment requirements.
- What this form is
- The DMV-12-IND Non-West Virginia Residency Statement asks you to attest to your residency, employment, active military, or student status and state where you intend to fulfill DUI Safety and Treatment requirements. It also requests your current address, date of birth, and Social Security Number. Attach current proof of the applicable status. The form states that the signature must be notarized or it will be rejected.
- Who needs it
- People attesting to qualifying residency, employment, military duty, or student status for fulfilling DUI Safety and Treatment requirements.
- Why it needs a notary
- Your signature must be notarized or the form will be rejected. You can complete notarization online with a commissioned online notary.
- How to submit it
- Attach current proof of residency, employment, military duty station, or college or university enrollment. The form says the signature must be notarized or it will be rejected.
Questions
Who uses the DMV-12-IND Non-West Virginia Residency Statement?
The form is for people attesting to residency, employment, active military, or student status in a state where they intend to fulfill DUI Safety and Treatment requirements.
What proof must accompany this statement?
The form asks you to attach current proof of residency, employment, military duty station, or college or university enrollment, depending on the status you attest to.
Does the DMV-12-IND need to be notarized?
Yes. The form says the signature must be notarized or the statement will be rejected. Notarization can be completed online with a commissioned online notary.