Form Mv-44edl - Application For Enhanced Permit, Driver License Or Non-Driver Id Card Page 2

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MV-44EDL (11/16)

DRIVER LICENSE and LEARNER PERMIT APPLICANTS ONLY

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

Yes

denied in this state or elsewhere, in the name you provide on this form or any other name?

Yes

If “Yes”, has your license, permit or privilege been restored, or has your application been approved?

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)?

Yes

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?

Yes

4. Have you lost the use of a leg, arm, hand or eye?

Yes

4a. If you need to renew your driver license and you marked “Yes”, did this occur since your last driver license?

Yes

4b. If you marked “NO” to 4a, has your condition gotten worse since your last driver license?

Yes

Junior License

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

(Relationship to Applicant)

(Date)

Teen Electronic Event Notification Service (TEENS)

I would like to enroll in the TEENS program to be notified if the under 18 year-old applicant

NYS Client ID of Consenting Parent or Guardian Above- Required

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.

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 ?

Yes

If YES, write the name of each one (if you turn in a license from another state, do not include that state):

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):

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).

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).

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.

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.

CERTIFICATION

I certify that the information I have given on this application is true. I certify that I am a citizen of the United States of America and a resident of

New York State. If I am applying for a replacement license or non-driver identification card, I certify that the license or nondriver identification card has been lost,

stolen or mutilated and that, if the lost license or non-driver identification card is found, I will turn it in to the Department of Motor Vehicles. If I am exchanging my

out-of-state license for a NYS license, I certify that I was a permanent resident of the state or province in which my license was issued at the time the license was

issued, that such license has been valid for at least 6 months, and that I have not failed a road test in NYS in the last 12 months. If I am a male at least 18 but

less than 26 years old, I consent to be registered with the Selective Service System, if so required by federal law, and authorize the forwarding of any personal

information required for such registration. My signature below also authorizes use of my credit card, if applicable.

I understand that the information and documentation that I have provided in connection with this application will be used to verify my identity, New York State

residency and United States citizenship. I understand that this information and documentation will be shared with the New York State and United States federal

entities for these verification purposes and I consent to this dissemination and use.

IMPORTANT: Making a false statement in any license or non-driver ID card application, or in any proof or statement in connection with it, or

deceiving or substituting, or causing another person to deceive or substitute in connection with such application, may subject you to criminal

prosecution for a misdemeanor or felony under the Vehicle and Traffic Law and/or the Penal Law.

DATE:

SIGN HERE

PLEASE PRINT NAME

CREDIT CARD AUTHORIZATION IF CARDHOLDER IS NOT THE APPLICANT:

Sign

My signature authorizes____________________________________________

Here

to use my credit card for payment of any fees in connection with this application and I