Fillable oo o o APPLICATION FOR PERMIT, DRIVER LICENSE

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oo o o APPLICATION FOR PERMIT, DRIVER LICENSE

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APPLYING FOR:
PURPOSE FOR APPLICATION:
MV-44 (1/18)
oo o
o
License
o
Permit
ID card
New
o
Change Type
o
Replacement
o
Renew Update Info
o
Transfer to NY
o
Conditional
o
Restricted
This form is also available at dmv.ny.gov
PRINT CLEARLY IN BLUE OR BLACK INK.
APPLICATION FOR PERMIT, DRIVER LICENSE OR NON-DRIVER ID CARD
PLEASE COMPLETE AND SIGN PAGE 2.
PAGE 1 OF 3
Image #
OFFICE USE ONLY
Month Day Year
* You must provide your SSN. Authority to collect your SSN is granted by Sections 490(3) and 502(1) of the Vehicle and
Traffic Law. The information will be used for exchange with other jurisdictions, to assist in verification of identity, and for
driver license sanctions pursuant to V&T Law Section 510(4-e) and 510(4-f). Your SSN will not be given to the public.
What is the change and the reason for it
(new license class, wrong date of birth, etc.)?
OTHER CHANGE:
Male Female
oo
SUFFIX
DATE OF BIRTH SEX HEIGHT
EYE COLOR TELEPHONE NUMBER (Home/Mobile)
SOCIAL SECURITY NUMBER
* (SSN)
Area Code
( )
ADDRESS WHERE YOU GET YOUR MAIL - Include Street Number and Name, Rural Delivery and/or box number (If PO Box, also fill in “Address Where You Live” below)
THIS ADDRESS WILL APPEAR ON YOUR STANDARD IDENTITY DOCUMENT
Apt. No. City or Town State Zip Code
If you answered yes to either of the questions above, then addresses on all vehicle registrations tied to your ID number will also be updated with this address, unless you
check this box
. If you are registered to vote, your voter registration record will be updated when you complete and submit this form. If you do NOT want your new address
on your voter registration record, check this box . If you do not check the box, your new address will be sent to the Board of Elections of your county of residence.
ADDRESS WHERE YOU LIVE REQUIRED IF DIFFERENT FROM ADDRESS FOR MAIL - DO NOT GIVE P.O. BOX.
THIS ADDRESS WILL APPEAR ON YOUR ENHANCED/REAL ID IDENTITY DOCUMENT
Apt. No. City or Town State Zip Code
County
County
Feet Inches
If “Yes”, print your former name exactly as it appears on your present license or non-driver ID card.
Has your name changed?
o
Yes
o
No
HAS YOUR MAILING ADDRESS CHANGED? o Yes o No
HAS THE ADDRESS WHERE YOU LIVE CHANGED?
o Yes o No
NEW YORK STATE ORGAN AND TISSUE DONATION
Check this box
to make a $1
voluntary donation
to the Life...Pass It
On Trust Fund for
organ and tissue
donation research
and outreach. Your
total transaction fee
will include the $1.
o
o
o
♥Donor Consent
Signature: X
Date
VETERAN STATUS
Check this box if you would like to have “Veteran” printed on the front of your photo document.
To enroll in the New York State Donate Life Registry, check the “yes” box and then sign and date below. You are certifying that you are: 16 years of age
or older; consenting to donate your organs and tissues for transplantation and research; authorizing DMV to transfer your name and identifying
information to the Donate Life Registry; and authorizing Donate Life NYS to give access to this information to federally regulated organ donation
organizations and NYS-licensed tissue and eye banks and hospitals, upon your death. “ORGAN DONOR” will be printed on the front of your DMV photo
document. You will receive a confirmation, which will also provide you an opportunity to limit your donation. If you are 16 or 17 years of age, parents/legal
guardians may change your decision upon your death. For more information, contact DLNYS at donatelife.ny.gov.
o
o
o
(You must fill out the following section)
You must present proof that indicates an honorable discharge from military service (DD-214, DD-215, or see form MV-44.1).
You must answer the following question: Would you like to be added to the Donate Life Registry?
Yes (sign and date consent below)
Skip This Question
SM
(Please check “yes” or “no”.)
VOTER REGISTRATION QUESTIONS
If you are not registered to vote where you live now, would you like to apply to register?
NOTE: If you do not check either box, you will be considered to have decided not to register to vote.
YES - Complete Voter Registration Application Section (Not necessary if you bring this form to a DMV office).
o
o
NO - I Decline to Register/Already Registered
IDENTIFICATION INFORMATION
ID NUMBER ON NYS DRIVER LICENSE, LEARNER PERMIT,
or NON-DRIVER ID CARD
Do you now have, or did you ever have a New York driver license, learner permit,
or non-driver ID card?
o Yes o No
Applying for a Non-Driver ID card will cancel any NY State driver license privilege.
FULL LAST NAME
FULL FIRST NAME
FULL MIDDLE NAME
Do you have or did you ever have a driver license that is valid or that
expired within the last two years, issued by another US State, the
District of Columbia or a Canadian Province?
o Yes o No
If “Yes”, where was it issued?
Date of Expiration: Type of License: Out-of-State License ID No.:
License
Class
Special
Conditions
O
F
F
I
C
E
U
S
E
o Birth Certificate
o U.S. Passport
o Foreign Passport
o Enhanced
o REAL ID
o Standard
(Not for Federal
Purposes)
o Driver License/ID
o Learner Permit
o MV-45
o Out-of-State License
o DHS Document(s)
o Medical Certificate (CDL Only)
o Image Retrieval
o Social Security Card
o Credit Card
o ATM Card
Other:
NI NA EI EA
Proof Submitted:
Document Type
Approved By Date
Office
o TEENS
CDL Certifications
Other
Restrictions
CERTIFICATION
MV-44 (1/18)
PAGE 2 OF 3
EYE TEST RESULTS
oPassed in Office oVision Registry oCorrective Lens
Applicant’s Signature
Examiner’s Initials
OFFICE
USE
o Junior License o Non-driver ID Card (under 16)
I am the parent or guardian of the applicant, and I consent to the issuance of a learner permit, license or (if under 16) a non-driver ID card to him/her. I
understand that I am responsible for certifying that the applicant has completed at least 50 hours of supervised “practice” driving, including 15 hours of driving
after sunset, prior to the applicant taking a road test, and that this certification (MV-262) must be presented at the time of the road test. Note to parent/guardian:
If the driver license applicant is 17 years old and has a Driver Education Student Certificate of Completion (MV-285), consent is not required.
Parent or Guardian
Sign Here
X
(Relationship to Applicant) (Date)
PARENT/GUARDIAN CONSENT
I would like to enroll in the TEENS program to be notified if the under 18 year-old applicant
receives a conviction, suspension, revocation or an accident on their license file. For more
information about this program, see form MV-1046, How to Enroll in TEENS or MV-1056,
TEENS FAQs. This is a FREE service.
Teen Electronic Event Notification Service (TEENS)
THESE QUESTIONS MUST BE COMPLETED FOR ALL LICENSE/PERMIT TRANSACTIONS
COMMERCIAL DRIVER LICENSE APPLICANTS ONLY
1. In the past 10 years, was a driver license issued to you from another state in the U.S. or the District of Columbia ? o Yes o No
If YES, write the name of each one
1. Has your driver license, learner permit, or privilege to drive a motor vehicle been suspended, revoked or cancelled, or has your application for a license been
denied in this state or elsewhere, in the name you provide on this form or any other name? o Yes o No
If “Yes”, has your license, permit or privilege been restored, or has your application been approved? o Yes o No
2. Have you received treatment, do you currently receive treatment, or do you take medication for any condition that causes unconsciousness or unawareness
(for example, a convulsive disorder, epilepsy, fainting or dizziness, or a heart condition)? o Yes o No
If you marked “Yes”, you must submit form MV-80U.1, even if you were released from the Medical Review Program. You can get this form at any Motor
Vehicles office or at dmv.ny.gov.
3. Do you need a hearing aid and/or full view mirror to drive a motor vehicle? o Yes o No
4. Have you lost the use of a leg, arm, hand or eye? o Yes o No
4a. If you need to renew your driver license and you marked “Yes”, did this occur since your last driver license? o Yes o No
4b. If you marked “NO” to 4a, has your condition gotten worse since your last driver license? o Yes o No
2. You MUST certify to DMV that you operate (or expect to operate) a commercial motor vehicle in one of the following four driving types (select only one):
o Non-excepted Interstate (NI) - Certified medical status is required. You are age 21 or older and you operate, or expect to operate, interstate (other than
for excepted operation).
o Non-excepted Intrastate (NA) - Certified medical status is required. You are age 18 or older and you operate, or expect to operate, in NYS only (other
than for excepted operation).
o Excepted Interstate (EI) -You are age 18 or older and you operate, or expect to operate, interstate in Excepted Operation ONLY. You must have A3 restriction.
o Excepted Intrastate (EA) - You are age 18 or older and you operate, or expect to operate, in Excepted Operation ONLY and in NYS ONLY. You must have A3
and K restrictions.
If the driving type you selected requires certified medical status (NI or NA) you must provide a legible copy of your current USDOT Medical Examiner’s
Certificate to DMV if it is not already on file. Please see DMV form MV-44.5 if additional information is needed to help you determine your driving type.
SIGN HERE
DATE:
PLEASE PRINT NAME
X
/ /
ID Number on NYS Driver License, Permit or Non-driver ID
Card of Consenting Parent or Guardian Above (Required)
I certify that the information I have given on this application and on any documentation provided in support of this application is true and complete.
I understand that making a false statement on this application, or submitting any documentation in support of this application that is false, may be punishable as
a criminal offense.
If I am applying for a replacement document, I certify that my NY State document has been lost, stolen, or mutilated.
If I am transferring an Out-of-State Driver License to a NY State Driver License, I certify that, when I obtained my out-of-state driver license, I was a permanent
resident of the state or province that issued the license, that license has been valid for at least 6 months, and I have not failed a driving skills road test in NY
State in the last 12 months.
If I am applying for a Conditional or Restricted Use License, I certify that I will pay the full tuition and other required fees for the rehabilitation program (if
applicable), attend the program (if required), and will drive within the conditions required for the restricted or conditional license. I understand that failure to do
so will result in the revocation of my restricted or conditional license and the reinstatement of the suspension or revocation against my full license.
If I am a male at least 18 but less than 26 years old, I understand that the act of making this application shall serve as consent to be registered with the
Selective Service System, if so required by federal law, and authorization of the forwarding of my personal information required for such registration.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
西班牙语信息：如果您有兴趣获得西班牙语的这
种选民登记表，请致电1-800-367-8683
스페인어로 된 정보 :이 유권자 등록 양식을 스페인
어로 얻으려면 1-800-367-8683으로 전화하십시오.
Información en español: si le interse obtener
este formulario de re-gistro del votante en
español, llame al 1-800-367-8683
reset/clear
MV-44 (1/18)
OFFICE USE ONLY
NEW YORK STATE VOTER REGISTRATION APPLICATION INFORMATION
(Please read before you complete application on the other side.)
Use the NYS Voter Registration Application to Register to Vote in NYS Elections, and/or:
To Register You Must:
change the name or address on your voter registration
become a member of a political party change your party membership
If you do not complete the NYS Voter Registration Application, you will be considered to have declined to register to vote. If you decline to register to vote,
the fact that you have declined to register will remain confidential and will be used only for voter registration purposes. If you do register to vote, the office at
which you submit a voter registration application will remain confidential and will only be used for voter registration purposes. If you believe that someone
has interfered with your right to register or decline to register to vote, your right to privacy in deciding whether to register or in applying to register to vote, or
your right to choose your own political party or other political preference, you may file a complaint with the NYS Board of Elections, 40 Steuben Street,
Albany, NY 12207-2109 (phone: 1-800-469-6872).
Your completed application will be sent to the Board of Elections and you will be notified by your County Board of Elections when your application has been
processed. If you have any questions about filling out the voter registration application or registering to vote, you should call your County Board of Elections
or call 1-800-FOR-VOTE (TDD/TTY dial 711) (only for voter registration questions). If you live in New York City, you should call 1-866-VOTE-NYC. You
may also find answers or tools at the NYS Board of Elections website: www.elections.ny.gov
l
be a U.S. citizen;
l
be 18 years old by the end of this year;
l
not be in prison or on parole for a felony conviction;
l
not claim the right to vote elsewhere
l
l
l
NEW YORK STATE VOTER REGISTRATION APPLICATION
Only fill this out if you want to register to vote or change your address or other information with the Board of Elections.
If you register to vote, your completed voter registration application will be sent directly to the Board of Elections. If you decline to register, your decision will
remain confidential. You will be notified by your County Board of Elections when your voter registration application has been processed.
Have you voted before?
o Yes o No
What Year?
Your name was
Your address was
Voting information that
has changed:
skip if this has not changed or
you have not voted before.
Your state or NYS
County was:
Are you a citizen of the U.S.?
o Yes o No
If you answer NO, you cannot register to vote
Will you be 18 years of age or older on or before election day?
o Yes o No
If you answer NO, you cannot register to vote unless you will be 18 by the end of the year.
X
DateSign
AFFIDAVIT: I swear or affirm that
l I am a citizen of the United States.
l I will have lived in the county, city, or village for at least 30 days before the election.
l I meet all requirements to register to vote in New York State.
l This is my signature or mark on the line below.
l The above information is true. I understand that if it is not true, I can be convicted and fined up to $5,000 and/or
jailed for up to four years.
I wish to enroll in a political party:
o Democratic party
o Republican party
o Conservative party
o Green party
o Working Families party
o Independence party
o Women’s Equality party
o Reform party
o Other
I do not wish to enroll in a political party
o No party
Political Party
Telephone Number (optional)
You must make 1
selection. Political
party enrollment is
optional but that, in
order to vote in a
primary election of a
political party, a voter
must enroll in that
political party unless
state party rules allow
otherwise.
MV-44 (1/18)
PAGE 3 OF 3
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oo o o APPLICATION FOR PERMIT, DRIVER LICENSE

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Completed 11 August 2021

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