New Hampshire Armed Forces Affidavit of Residency Form
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DSMV 76 (Rev. 06/10)
John J. Barthelmes
Commissioner of Safety
STATE OF NEW HAMPSHIRE
DEPARTMENT OF SAFETY
Division of Motor Vehicles
Stephen E. Merrill Building
23 Hazen Drive, Concord, NH 03305
TDD Access: Relay NH 1-800-735-2964
Director of Motor Vehicles
Armed Forces Affidavit of Residency
This certificate is required for all New Hampshire residents who are members of the Armed Forces who renew
their Driver License without a fee. In order to qualify, you must have been a resident of New Hampshire at the
time of your original induction, or call to active duty, and you must renew an existing New Hampshire Driver
License. Members of National Guard units and Reserve components not currently on active duty do not qualify
Except for signatures, please print or type.
I, , certify that my home of record is
, New Hampshire, and that I originally
(Street Address) (City or Town)
entered the at , New Hampshire on
(Branch of Armed Forces)
(City or Town)
, and that my tour of Active Duty is for two or more years, and my current
(Original Entry Date)
enlistment terminates on , and that my privilege to operate motor vehicles is not
under suspension or revocation by any state.
Date of Birth
This is to certify that the above named person is under my command and that s/he signed the foregoing
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