PA State Rep. Mark Keller

Contact My Office

District Office

18 West Main Street
PO Box 9
New Bloomfield PA 17068
Tel: 717-582-8119
Fax: 717-582-8979
9 a.m. to 4 p.m.

Franklin County Office
1270 Crottlestown Road
Chambersburg, PA, 17201
(717) 267-2047

Room 5
Capitol East Wing Building
PO Box 202086
Harrisburg, PA 17120-2086
Tel: 717-783-1593
Fax: 717-705-7012

Email:
mkeller@pahousegop.com

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Forms and Applications

Miscellaneous

Birth Certificate Birth Certificate

Child Abuse History Clearance Form Child Abuse History Clearance Form

Civil Service Employment Application Civil Service Employment Application

Commonwealth Employment Application (Personal Data Sheet) Commonwealth Employment Application (Personal Data Sheet)

Criminal Record Check Form Criminal Record Check Form

DCED Single Application DCED Single Application

Death Certificate Death Certificate

Federal Stafford Loan Form Federal Stafford Loan Form

Insurance Complaint Form Insurance Complaint Form

Fictitious Name Application Fictitious Name Application

Medicaid Application Medicaid Application

Notary Public Application Notary Public Application

PACE / PACENET Application PACE / PACENET Application

PAE Family Adoption Form PAE Family Adoption Form

PA Securities Commission Complaint Form PA Securities Commission Complaint Form

Unemployment Compensation Benefits Application Unemployment Compensation Benefits Application

Voter Registration Application Voter Registration Application

Transportation

DL-31 Application to Add / Extend / Replace / Change / Correct Non-Commercial Learner's Permit DL-31 Application to Add / Extend / Replace / Change / Correct Non-Commercial Learner's Permit

DL-80 Application for Change / Correction / Replacement of Non-Commercial Driver's License DL-80 Application for Change / Correction / Replacement of Non-Commercial Driver's License

DL-80CD Application to Replace / Correct Commercial Driver's License DL-80CD Application to Replace / Correct Commercial Driver's License

DL-135 Request for Vehicle Information DL-135 Request for Vehicle Information

DL-143 Non-Commercial Driver's License Renewal Application DL-143 Non-Commercial Driver's License Renewal Application

DL-180 Initial Non-Commercial Learner's Permit Application DL-180 Initial Non-Commercial Learner's Permit Application

DL-503 Request for Driver Information (copy of Driving Record) DL-503 Request for Driver Information (copy of Driving Record)

MV-41 Application for Correction or Change of Vehicle Record MV-41 Application for Correction or Change of Vehicle Record

MV-41A Application for Correction or Change of Name MV-41A Application for Correction or Change of Name

MV-44 Application for Duplicate Registration Card, Replacement of Registration Plate, Renewal Sticker or Weight Class Sticker of Transfer of Registration MV-44 Application for Duplicate Registration Card, Replacement of Registration Plate, Renewal Sticker or Weight Class Sticker of Transfer of Registration

MV-63 Change of Address for Driver's License, Photo ID and Vehicle Registration MV-63 Change of Address for Driver's License, Photo ID and Vehicle Registration

MV-140 Request for Registration / Renewals MV-140 Request for Registration / Renewals

MV-145A Person with Disability Parking Placard Application MV-145A Person with Disability Parking Placard Application

MV-38O Application for Duplicate Certificate of Title by Owner MV-38O Application for Duplicate Certificate of Title by Owner

MV-904 Application for Special Registration Plate (Personalized) MV-904 Application for Special Registration Plate (Personalized)

MV-911 Application for Special Fund License Plate MV-911 Application for Special Fund License Plate

MV-371 Application for A Retired Persons $10.00 Processing Fee On A Vehicle Registration MV-371 Application for A Retired Persons $10.00 Processing Fee On A Vehicle Registration

Revenue

PA-40 Income Tax Return PA-40 Income Tax Return

PA-100 Enterprise Registration Form PA-100 Enterprise Registration Form

PA-1000 Property Tax/Rent Rebate Form PA-1000 Property Tax/Rent Rebate Form