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

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MV-44 (8/17)
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):
NYS license in exchange for a license from another
ID card
Change
Learner Permit
Renewal
US State, the District of Columbia or Canadian Province
IDENTIFICATION INFORMATION
Do you now have, or did you ever have a New York:
ID NUMBER ON NYS DRIVER LICENSE, LEARNER
}
PERMIT, or NON-DRIVER ID CARD
Driver license? . . . . .
Yes
No
If “Yes”, enter the 9-digit ID number as it appears on the
Learner permit? . . . .
Yes
No
front of 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
HEIGHT
EYE COLOR
TELEPHONE NUMBER
Month
Day
Year
Male
Female
Feet
Inches
Area Code
(
)
If “Yes”, print your former
MOBILE PHONE NUMBER
EMAIL
name exactly as it appears on your present license or non-driver ID card.
Area Code
(
)
*
* You must provide your SSN. Authority to collect your SSN is granted by Sections 490.3 and 502 of the Vehicle and
SOCIAL SECURITY NUMBER
(SSN)
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 THE ADDRESS WHERE YOU LIVE CHANGED?
Yes
No
HAS YOUR MAILING ADDRESS CHANGED?
Yes
No
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.
What is the change and the reason for it
(new 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
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: 16
$1 voluntary donation to the
years of age or older; consenting to donate your organs and tissues for transplantation, research or both; authorizing DMV to transfer your name and
Life...Pass It On Trust Fund
identifying information to DOH for enrollment in the Registry; and authorizing DOH to allow access to this information to federally regulated organ
for organ and tissue donation
donation organizations and NYS-licensed tissue and eye banks and hospitals, upon your death. “ORGAN DONOR” will be printed on the front of your
research and outreach. Your
DMV photo document. You will receive a confirmation from DOH, which will also provide you an opportunity to limit your donation. If you are 16 or 17
total transaction fee will
years of age, parents/legal guardians may rescind or amend your decision upon your death.
include the $1.
Yes (sign and date consent below)
You must answer the following question: Would you like to be added to the Donate Life Registry?
t
Donor Consent Signature:
ate:_____________
________________________________________________________________
D
VOTER REGISTRATION QUESTIONS
(Please check “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?
YES - Complete Voter Registration Application Section (Not necessary if you bring this form to a DMV office).
NO - I Decline to Register/Already Registered
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:
Approved By
Date
I
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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