CERTIFICATION OF RESIDENCE
This Certification of Residence can be used to provide proof of principal residence address and should be completed by
the individual making the certification and the applicant for which the certification applies. This form must accompany
one additional proof of principal residence in the applicant’s name. A list of acceptable residence proofs can be found on
form ID-44EDL.
Relationship of individual making certification can include:
Co-resident
•
Employer
•
Landlord
•
Neighbor
•
Parent or Legal Guardian
•
School Official
•
Spouse
•
t
CERTIFICATION
I, , as the
certify , currently resides at
and that this name is the name by which (s)he is commonly known and that (s)he resides at the address above. I state
that the information I have given in this certification is true to the best of my knowledge. I understand that any false
statement I have made on this certification is a misdemeanor under Section 392 of the Vehicle and Traffic Law.
Individual Making Certification (Print Name Here)
:
Signature of Individual Making Certification t
Applicant (Print Name Here):
Signature of Applicant t
MAKING ANY FALSE STATEMENT ON THIS CERTIFICATION OF RESIDENCE IS PUNISHABLE BY LAW.
(Name)
(Relationship of Individual Making Certification)
(Address)
(Name of Applicant)
FOR OFFICE USE
Signature of DMV Employee Accepting Proof
t
Signature of DMV Supervisor Accepting Proof: t Date:
MV-44NYR (7/16)
