Form 142, Request for Cancellation or Surrender of a Driver License or ID Completed Form Examples and Samples
Explore a detailed example of Form 142, the Request for Cancellation or Surrender of a Driver License or ID. This sample demonstrates accurate completion for those surrendering their license due to relocation, showing personal details, reasons for cancellation, and compliance with DMV requirements.
Form 142 Example – Cancellation of Driver License
How this form was filled:
This example demonstrates the completion of Form 142 for a driver license cancellation when the license holder has moved out of state. The form includes the individual's personal information, the reason for cancellation, and the required signature and date.
Information used to fill out the document:
- Full Name: Jane Smith
- Driver License Number: D12345678
- Date of Birth: 01/15/1990
- Current Address: 456 Elm Street, New Town, CA, 90210
- Reason for Cancellation: Moved out of state
- Signature: Jane Smith
- Date: 03/28/2025
What this filled form sample shows:
- Accurate completion of personal information including name and address
- Properly stated reason for cancellation as 'Moved out of state'
- Correctly formatted signature and date
Form specifications and details:
| Use Case: | Cancellation of Driver License due to relocation |
| Categories: | driver license forms |