Form Mv-44 - Application For Permit, Driver License Or Non-Driver Id Card

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MV-44 (5/15)
APPLICATION FOR PERMIT, DRIVER LICENSE OR NON-DRIVER ID CARD
PLEASE PRINT CLEARLY IN BLUE OR BLACK INK.
OFFICE USE ONLY
This form is also available on DMV’s web site at:
dmv.ny.gov
Image #
I AM APPLYING FOR A
(check any that apply):
N
YS license in exchange for a license from another
Learn er Permit
ID card
Change
Renewal
Replacement
U
S State, the District of Columbia or Canadian Province
IDENTIFICATION INFORMATION
Do you now have, or did you ever have a New York:
}
NYS DRIVER LICENSE, LEARNER PERMIT, or
NON-DRIVER ID CARD NUMBER
Driver license? . . . . .
Yes
No
If “Yes”, enter the identification number as it appears
Learner permit? . . . .
Yes
No
on the license, learner permit, or non-driver ID card.
Non-driver ID Card?
Yes
No
FULL LAST 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
FULL FIRST NAME
District of Columbia or a Canadian Province?
Yes
No
If “Yes”, where was it issued? ____________________________
FULL MIDDLE NAME
Date of Expiration: Type of License:
Out-of-State License ID No.:
SUFFIX
DATE OF BIRTH
SEX
H
EIGHT
EYE COLOR
DAY PHONE NO.
Area Code
Month
Day
Year
Male
Female
Feet
Inches
(
)
*
*
SOCIAL SECURITY NUMBER
(SSN)
You must provide your SSN. Authority to collect your SSN is granted by Sections 490.3 and 502 of the Vehicle and
Traffic Law. The information will be used only for exchange with other jurisdictions, to assist in verification of
identity, and to invoke driver license sanctions pursuant to V&T Law Section 510(4-e) and 510(4-f). Your
number will not be given to the public, or appear on any form or information request.
ADDRESS WHERE YOU GET YOUR MAIL (
This address will appear on your document.)
- Include Street Number and Name, Rural Delivery and/or box number (If PO Box, also fill in “Address Where You Live” below)
Apt. No.
City or Town
State
Zip Code
County
ADDRESS WHERE YOU LIVE
IF DIFFERENT FROM MAILING ADDRESS - DO NOT GIVE P.O. BOX.
Apt. No.
City or Town
State
Zip Code
County
Has your mailing address changed?
Yes
No
Has the address where you live changed?
Yes
No
What is the change and the reason for it (new
OTHER CHANGE: license class, wrong date of birth, etc.)?
Ch
eck this box if you would like to have “Veteran” printed on the front of your photo document.
VETERAN STATUS
You must present proof that indicates an honorable discharge from military service. For additional information, please see form MV-44.1.
NEW YORK STATE ORGAN AND TISSUE DONATION
(You must fill out the following section)
Check this box to make a $1
SM
voluntary contribution to the
To enroll in the NYS Department of Health’s Donate Life Registry, check the “yes” box and then sign and date below. You are certifying
that you are: 18 years or older; consenting to donate all of your organs and tissues for transplantation, research or both; authorizing DMV
Life...Pass It On Trust Fund. The $1
to transfer your name and identifying information to DOH for enrollment in the Registry; and authorizing DOH to allow access to this
donation will be added to your total
information to federally regulated organ donation organizations and NYS-licensed tissue and eye banks and hospitals, upon your death.
transaction fee. A contribution to
“ORGAN DONOR” will be printed on the front of your DMV photo document. You will receive a confirmation from DOH, which will also
the Fund is used for organ donation
provide you an opportunity to limit your donation.
and transplant research and
Yes (sign and date consent below)
You must answer the following question: Would you like to be added to the Donate Life Registry?
educational projects promoting
Skip This Question
organ and tissue donation.
ç
Donor Consent Signature:
a
te:_____________
________________________________________________________________
D
VOTER REGISTRATION QUESTIONS
(Please answer “yes” or “no”.)
NOTE: If you do not check either box, you will be considered to have decided not to register to vote.
If you are not registered to vote where you live now, would you like to apply to register, or if you are changing your address, would you like the Board of Elections to be notified?
YES - Complete Voter Registration Application Section (Not necessary
NO - I Decline to Register/Already Registered/I do not want to notify
if you will be applying in person at a DMV office).
the Board of Elections of my change of address.
PLEASE COMPLETE AND SIGN PAGE 2
.
Other
F
License
A
B
C
NCDL-C
D
DJ
Restrictions
O
Class
E
ID
M
MJ
R
Endorsements
AM
DP
LR
TR
LS
BC
Special
O
Conditions
NI
NA
EI
EA
CDL Certifications
ML
NF
TD
UC
UP
UR
X8
XT
F
F
Proof Submitted:
I
Approved By
Date
Driver License/ID
DHS Document(s)
Social Security Card
TEENS
C
Birth Certificate
Learner Permit
Medical Certificate (CDL Only)
Credit Card
E
U.S. Passport
License/Permit
MV-45
Image Retrieval
ATM Card
Office
Surrendered for
U
Foreign Passport
Out of-State-License
Non-Driver ID Card
S
Other:
E

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