Form Mv-372 - Application For A License To Operate A Private Service Bureau Or Open A Branch Office Page 2
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2EMPLOYEES/RUNNERS/AGENTS (PAID OR UNPAID)
List all employees/runners/agents (paid or unpaid) working at or associated with the Private Service Bureau.
Name
Address
NYS Driver License or Non-Driver ID No.*
*Note:
ALL EMPLOYEES/RUNNERS/AGENTS (PAID OR UNPAID) WHO HAVE DIRECT IN-PERSON CONTACT WITH CUSTOMERS AND/OR
DMV, MUST HAVE EITHER A VALID NYS DRIVER LICENSE OR A VALID NYS NON-DRIVER IDENTIFICATION CARD.
CONDITIONS
As a condition for issuing a Private Service Bureau License, the undersigned agree to all of the following conditions:
A. To maintain adequate records, as required by the New York State Vehicle and Traffic Law and Rules and Regulations, and to permit the inspection of
such records at reasonable times by an authorized representative of DMV. The Department of Motor Vehicles considers “reasonable time” to be
9:00 A.M. to 5:00 P.M., Monday thru Friday.
B. Not to employ or use employees/runners/agents (paid or unpaid) who have been convicted of a felony or misdemeanor unless each employee is
approved by the Commissioner of Motor Vehicles.
C. To comply with all state laws and regulations, and all municipal ordinances and regulations relating to public health and public safety for the business facility.
D. To comply with all provisions of the New York State Vehicle and Traffic Law and Rules and Regulations relating to a Private Service Bureau.
AFFIRMATION
All of the undersigned affirm they have read the entire application, are familiar with all its contents, and all answers, statements and all other matters in it are true.
Each owner, partner, manager, corporation officer and major stockholder (20% or more) of the Private Service Bureau must sign in the space provided below.
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To knowingly make a false statement or conceal a material fact in this application is a criminal
offense, and will result in the revocation of your Private Service Bureau License. False statements
are punishable under Section 210.45 of the Penal Code.
Please return this form with all required
documentation and application fee to:
Pursuant to Vehicle and Traffic Law - 392, any person knowingly making a false statement in an
Private Service Bureau Unit
application for any document issued by the Department or in any proof or statement in writing in
NYS Department of Motor Vehicles
connection with such an application shall be guilty of a misdemeanor.
6 Empire Plaza, Room 322P
Albany NY 12228
Vehicle and Traffic Law - 394(5) authorizes the Department to suspend or revoke a Private Service
Bureau license or refuse to issue a renewal thereof where the licensee has made a material false
statement or concealed a material fact in connection with his or her application for a license or renewal.
MV-372 (10/15)
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