Illinois Form DSD X 172 Affidavit Guide – Form DSD X 172 is the official Affidavit of Inability to Surrender Driver’s License, Identification Card, or Permit issued by the Illinois Secretary of State Driver Services Department. This sworn statement allows Illinois residents (and certain out-of-state applicants) to formally declare that they cannot physically turn in their current Illinois driver’s license, state ID card, or restricted driving permit.
The form is commonly required when a document has been lost, stolen, destroyed, or is otherwise not in the person’s possession. It is a fillable PDF available directly from the Illinois Secretary of State website and remains the current version (DSD X-172.2, printed November 2019).
You can download the official form here: Illinois Form DSD X 172 PDF.
When Do You Need Form DSD X 172?
Illinois law and Secretary of State procedures generally require applicants to surrender any previously issued Illinois driver’s license, ID card, or permit when applying for a new, duplicate, corrected, or renewed credential. When that is impossible, Form DSD X 172 provides a legal alternative.
Common situations that require this affidavit include:
- Your driver’s license, state ID, or permit was lost or stolen.
- The document was destroyed (fire, flood, etc.).
- You no longer have physical possession for any other reason beyond your control.
- You are completing certain administrative processes with the Driver Services Department (including some medical review or special license unit cases) and cannot surrender the credential.
Note: Simply losing your license does not automatically require this form for a routine duplicate. However, if a facility or the Central Services Division specifically requests an affidavit of inability to surrender, Form DSD X 172 is the correct document.
Official Form Details and Contact Information
The form is issued by:
- Office of the Secretary of State
- Driver Services Department – Central Services Division
- 2701 S. Dirksen Parkway, Springfield, IL 62723
- Phone: 217-782-7044
- Website: ilsos.gov
The complete list of Driver’s License and ID Card forms, including DSD X 172, is maintained on the official publications page: Driver’s License and ID Card Publications and Forms.
How to Complete Form DSD X 172 Step by Step?
The form is a one-page sworn affidavit. Follow these steps carefully:
- County of – Enter the Illinois county where you are signing the affidavit.
- Full Legal Name – Print your first name, middle name, and last name exactly as they appear on your records.
- Residence Address – Provide your complete current street address, apartment number (if any), city, state, and ZIP code.
- Date of Birth – Enter the day, month, and year of your birth.
- Previously Issued Credential – Check the appropriate box(es) and fill in the corresponding number(s):
- Illinois Driver’s License number
- Illinois Identification Card number
- Restricted Driving Permit number
- Or an out-of-state driver’s license/ID (include the state, number, and expiration date)
- Reason for Inability to Surrender – Clearly explain why you cannot surrender the document (e.g., “lost on [date],” “stolen and reported to police,” “destroyed in fire”). State that the document is not now in or subject to your possession.
- Promise to Surrender – The form includes a mandatory statement that if the document later comes into your possession, you will promptly surrender it to the Secretary of State.
- Signature and Date – Sign and date the form in the presence of a notary public. The phrase “being first duly sworn” means the affidavit must be notarized.
Download the fillable PDF and complete it on a computer using Adobe Acrobat Reader for best results, then print and sign.
How and Where to Submit Form DSD X 172?
Submission methods depend on the specific transaction:
- In most cases, bring the completed, notarized original to a Driver Services facility when applying for a duplicate, corrected, or new credential.
- For certain Central Services or medical review matters, mail the form (preferably via trackable service such as USPS or FedEx) to:
Central Services Division
2701 S. Dirksen Parkway
Springfield, IL 62723
Always keep a copy for your records. If the form is required as part of a larger application packet, follow any additional instructions provided by the facility or the department.
Important Tips for U.S. Residents Using This Form
- The form must be notarized. Unsigned or un-notarized versions are not accepted.
- Provide accurate information. False statements on a sworn affidavit can have legal consequences.
- If your license or ID was stolen, file a police report. Some facilities may ask for the report number.
- When applying for a duplicate or renewal without the original document, you will still need to present acceptable proof of written signature and any other required identification documents. See the official Acceptable Identification Documents list.
- The form does not itself authorize driving. You must still complete the normal process for a valid temporary or permanent credential.
- Forms should be downloaded from the official Illinois Secretary of State website only to ensure you have the current version.
Download the Official Form DSD X 172
Get the free, fillable PDF directly from the Illinois Secretary of State:
For the full list of current driver’s license and ID forms, visit the official publications page: ilsos.gov Driver’s License and ID Card Publications and Forms.
Related Illinois Secretary of State Resources
- Illinois Secretary of State Official Website
- All Driver’s License & ID Card Forms
- Acceptable Identification Documents Chart
- Driver Services phone: 217-782-7044
This guide is based on the official Illinois Secretary of State Form DSD X 172 and related publications available on ilsos.gov. Always verify the most current requirements directly with the Driver Services Department or your local facility, as procedures can be updated.