Form Mv-44 - Application For Driver License Or Non-Driver Id Card Page 2

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MV-44 (8/13)

PAGE 2 OF 3

DRIVER LICENSE and LEARNER PERMIT APPLICANTS ONLY

1. Have you had a driver license, learner permit, or privilege to operate a motor vehicle suspended, revoked or cancelled, or an application for a license denied

in this state or elsewhere, in this or any other name?

Yes

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

Yes

2. Have you had, or are you currently receiving treatment or taking medication for any condition which causes unconsciousness or unawareness such as

convulsive disorder, epilepsy, fainting or dizzy spells, or heart ailment?

Yes

If “Yes”, you and your doctor must complete form MV-80U.1, even if you have been released from the Medical Review Program. This form can be obtained at

any Motor Vehicles office or at

3. Do you need a hearing aid or full view mirror while operating a motor vehicle?

Yes

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

Yes

4a. If you are renewing your license and answered “Yes”, is this a new condition since your last license?

Yes

4b. If you answered “NO” to 4a, has your condition worsened since your last license?

Yes

PARENT/GUARDIAN CONSENT

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 CMV in one of the following four driving types (select only one):

Non-excepted Interstate (NI) - certified medical status required. (Age 21 or older; operate/expect to operate Interstate)

Non-excepted Intrastate (NA) -certified medical status required. (Age 18 or older; operate/expect to operate in NYS only; must have K restriction)

Excepted Interstate (EI) - (Age 18 or older; operate/expect to operate Excepted Operation Only; must have A3 restriction)

Excepted Intrastate (EA) - (Age 18 or older: operate/expect to operate Excepted Operation Only and in NYS Only; must have A3 and K restriction)

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. If I am applying for a replacement license or non-driver

identification card, I certify that the license or non-driver 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.

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.

PLEASE PRINT

SIGN HERE

NAME

CREDIT CARD AUTHORIZATION IF CARDHOLDER IS NOT THE APPLICANT:

Sign

My signature authorizes_______________________________________________

Here