Tile,prep cook,wharehouse

Name:

Date of Birth

CRYSTAL DAWN OPPELT

**/**/****

Home Address:

*** * ******** ** *** A

Dallas, TEXAS 75211

DL Number:

DL Expiration Date:

License Class:

ID Number:

18597329

**/**/****

C

22533465

Name:

Primary:

Secondary:

Cardholder Name:

VISA:

CRYSTAL DAWN OPPELT

Your Emergency Contacts are:

, EDELIA

Mailing Address:

733 N Plymouth Rd Apt A

Dallas, TEXAS 75211

DALLAS

UNITED STATES

Billing Information:

400 S.Clinton Ave

Dallas, TEXAS 75208

Stephen C.Pereyda

XXXXXXXXXXXX4123

Selected Services:

Driver License

Replacement or Address

Change: $10.00

Texas.gov Fee: $1.00

Selected Options:

I selected the following options:

Become an Organ Donor — No

Renewal or Replacement Receipt and Temporary Driver License Permit This is your temporary driver license or ID card. You may choose to receive the temporary driver license or ID by email, but you must print it in order for it to be a valid document. It usually takes two to three weeks from the date of your transaction for a driver license or identification card to be mailed to you. You may check the mailing status of your card online at www.dps.texas.gov/DriverLicense/OnlineServices.htm Carry this portion with your driver license or ID card. This temporary card is valid for 60 days from August 24, 2021.

Payment Receipt

Texas.gov Price

*The Texas.gov Price will include any donations listed above.

$11.00

Transaction Date:

Confirmation Number:

August 24, 2021 12:22:02 PM CDT

405DL77977577

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