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

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MV-44EDL (11/16)

APPLICATION FOR ENHANCED PERMIT, DRIVER LICENSE

OR NON-DRIVER ID CARD

PRINT CLEARLY IN BLUE OR BLACK INK.

OFFICE USE ONLY

This form is also available at dmv.ny.gov

Image #

MARK THE BOX OF THE TYPE OF DOCUMENT OR SERVICE YOU NEED

(mark all that apply):

Upgrade Current

Learner

NYS license in exchange for a license from another US

Renewal

Replacement

Change

card

Document to EDL

Permit

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

If “Yes”, enter the identification number as it appears

Learner permit? . . . .

Yes

on the license, learner permit, or non-driver ID card.

Non-driver ID Card?

Yes

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

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

HEIGHT

EYE COLOR

TELEPHONE NUMBER

Month

Day

Year

Male

Female

Feet

Inches

Area Code

(

)

If “Yes”, print your former

name exactly as it appears on your present license or non-driver ID card.

MOBILE PHONE NUMBER

Area Code

(

)

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

Has the address where you live changed?

Yes

What is the change and the reason for it (new

OTHER CHANGE:

license class, wrong date of birth, etc.)?

Check 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

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

Life...Pass It On Trust Fund.

are: 16 years of age or older; consenting to donate your organs and tissues for transplantation, research or both; authorizing DMV to transfer

The $1 donation will be added

your name and identifying information to DOH for enrollment in the Registry; and authorizing DOH to allow access to this information to federally

to your total transaction fee. A

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 from DOH, which will also provide you an opportunity to limit

contribution to the Fund is

your donation. If you are 16 or 17 years of age, parents/legal guardians may rescind or amend your decision upon your death.

used for organ 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

♥

Donor Consent Signature:

ate:_____________

organ and tissue donation.

________________________________________________________________

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

License

NCDL-C

Restrictions

Class

Endorsements

Special