Fillable ONLINE PERMIT TEST PARENT/GUARDIAN CERTIFICATION (New York State)

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ONLINE PERMIT TEST PARENT/GUARDIAN CERTIFICATION (New York State)

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ONLINE PERMIT TEST
PARENT/GUARDIAN CERTIFICATION
IMPORTANT: DO NOT SIGN THIS FORM UNTIL YOU ARE WITH A MOTOR VEHICLES REPRESENTATIVE
I, , certify as the parent/legal guardian of ,
Print Parent/Guardian Name Applicant Name
that I observed my child or ward complete the New York State Department of Motor Vehicles knowledge test for a Class
D or Class M Learner’s Permit and that from my own observation, the applicant answered all items on the knowledge test
without the assistance of any person(s) and without reference to materials of any kind. I understand that making a false state-
ment, or submitting any false documentation in support of an application, may be punishable as a criminal offense.
IMPORTANT: DO NOT SIGN THIS FORM UNTIL YOU ARE WITH A MOTOR VEHICLES REPRESENTATIVE
Parent/Guardian Signature
Print Parent/Guardian Name
Parent/Guardian Mailing Address
Applicant Signature
Print Applicant Name
MV-263 (7/20)
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ONLINE PERMIT TEST PARENTGUARDIAN CERTIFICATION (New York State)

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Completed 19 June 2021

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