Form Mv-522 - Driving School Renewal Application

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DMV USE ONLY
DRIVING SCHOOL
License
Expiration
Number
Date
RENEWAL APPLICATION
Date
Fee
Processed
m
q
INSTRUCTIONS è
è
è
A
B
C
D
E
G
F
COMPLETE
and
REVIEW CHECKLIST
FOLLOW MAILING INSTRUCTIONS
Please note: Fill in all required information and sign this form. If using a pen, print clearly in blue or black ink. Make a copy for your records
and mail the completed, signed form to the address noted on page 2.
Driving School licenses are renewed for two years.
A
BUSINESS INFORMATION
Name of Driving
Phone Number
School
Address of
City
State
Zip Code
School
Branch Name
If more than
and Address
2 branches,
Branch Name
attach additional
and Address
sheet
Fax
Last Name of Owner
First
M.I.
Number
or Principal Authorized Official
Federal ID
Type of Business (check one of the following)
o
o
o
o
Number
Sole Proprietorship
Partnership
Corporation
Other (describe)________________________________
NOTE: Businesses regulated by the Department of Motor Vehicles are required to provide their Social Security numbers and Federal ID numbers
to the Department of Taxation and Finance, upon request, for tax administration purposes pursuant to Section 5 of the New York State Tax Law.
E-mail Address
Driving School Website Address
B
Indicate ALL services your driving school provides.
SERVICES:
1. What type(s) of vehicles(s) are you using for instruction? [check all that apply]:
o
o
o
o
o
o
Auto
Bus
Motorcycle
Tractor-Trailer
Truck
None
(If your driving school provides vehicles for instruction, you MUST attach a completed form MV-527, List of Driving
CHECK ONE
School Vehicles)
YES
NO
2. Do you teach the Pre-Licensing Course?
(If “yes” you MUST attach a completed form MV-278.6,
o
o
Authorized Signature List - Pre-Licensing Course) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
o
o
3. Do you provide any Private Service Bureau (PSB) functions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Do you teach the Point and Insurance Reduction Program (PIRP)?
(If “yes”, provide the name(s)of your
o
o
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Delivery Agency and Sponsor in the space below).
Delivery Agency Name: ____________________________________________________________________________
Sponsor Name: ____________________________________________________________________________
Delivery Agency Name: ____________________________________________________________________________
Sponsor Name: ____________________________________________________________________________
(If more than two, list names on separate page)
C
CHECK ONE
ANSWER ALL QUESTIONS:
YES
NO
o
o
1. Has there been any change of owner, partner, corporate officer, major stockholder or managing member of the driving school?.
2. Have any of the owners, partners, corporate officers, managing members or major stockholders been convicted of a crime
or felony involving violence, dishonesty, deceit, indecency, degeneracy or moral turpitude? (If “yes”, attach sheet with
o
o
explanation) ...............................................................................................................................................................................
o
o
3. Do you contract with any public or private high schools and or colleges to provide part of a Driver Education Course? . . .
Continue on Page 2
PAGE 1 OF 2
MV-522 (2/17)

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