Lakeland ID/LID Request Form

Lakeland ID Number Request Form.

Requests are answered in the order received, please be patient during open registration periods.

Full Name:

Date of Birth:

Last Four Digits of your Social Security Number:

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Current Contact Information

Street:

City:

State:

Zip:

Personal Email Address:

Home Phone:

Cell Phone:

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Contact Information in our system (only provide if different then current)

Street1:

City1:

State1:

Zip1:

Personal eMail Address1

Home Phone1:

Cell Phone1: