Form Mv-44cr - Restricted Use Or Conditional Driver License Application
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RESTRICTED USE OR CONDITIONAL
Case
No.
MV-44CR (09/17)
DRIVER LICENSE APPLICATION
Order
No.
PLEASE PRINT CLEARLY IN BLUE OR BLACK INK.
LAM
LRN
LDP
LNO
IMPORTANT: You cannot use a restricted use license to drive a vehicle for hire, unless your license is suspended or revoked because of an uninsured accident,
an insurance lapse, uninsured operation of a motor vehicle, or for delinquent child support payments. You cannot use a restricted use license to operate a
commercial vehicle. You cannot use a conditional license to drive a commercial vehicle or a vehicle for hire.
CHECK THE BOX OF THE TYPE OF SERVICE YOU NEED (YOU CAN MARK MORE THAN ONE)
o
o
o
o
o
Apply for a
Apply for a restricted
Replace a restricted use or
Renew a restricted use or
Change information on a
use license
conditional license
conditional license
conditional license
restricted use or conditional license
NYS DRIVER LICENSE OR NON-DRIVER ID CARD NUMBER
FULL LAST NAME
*
SOCIAL SECURITY NUMBER
(SSN)
FULL FIRST NAME
*
You must provide your SSN. Authority to collect your SSN is granted by Sections
490.3 and 502 of the Vehicle and Traffic Law. The information will be used only for
FULL MIDDLE NAME
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.
SUFFIX
DATE OF BIRTH
SEX
HEIGHT
EYE COLOR
TELEPHONE NUMBER
Male
Female
Area Code
Month
Day
Year
Feet
Inches
o
o
(
)
If “Yes”, print your former
name exactly as it appears on your present license or non-driver ID card.
MOBILE PHONE NUMBER
EMAIL
Area Code
(
)
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
o
o
o
o
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
o
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
o
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
OTHER CHANGE:
license class, wrong date of birth, etc.)?
o
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 more information, refer to form MV-44.1.
NEW YORK STATE ORGAN AND TISSUE DONATION
(You must fill out the following section)
o
Check this box to make a $1
To enroll in the New York State Donate Life
SM
Registry, check the “yes” box and then sign and date below. You are certifying that you are: 16 years of
voluntary contribution to the
age or older; consenting to donate your organs and tissues for transplantation and research; authorizing DMV to transfer your name and identifying
Life...Pass It On Trust Fund for
information to the Donate Life Registry; and authorizing Donate Life NYS to give access to this information to federally regulated organ donation
organ and tissue donation
organizations and NYS-licensed tissue and eye banks and hospitals upon your death. “ORGAN DONOR” will be printed on the front of your DMV
photo document. You will receive a confirmation, which will provide you an opportunity to limit your donation. If you are 16 or 17 years of age,
research and outreach. Your
parents/legal guardians may change your decision upon your death. For more information, contact DLNYS at donatelife.ny.gov.
total transaction fee will
o
Yes (sign and date consent below)
You must answer the following question: Would you like to be added to the Donate Life Registry?
include the $1.
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Skip This Question
♥
ç
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?
o
o
YES - Complete Voter Registration Application Section
NO - I Decline to Register/Already Registered.
(Not necessary if you bring this form to a DMV office).
PLEASE COMPLETE AND SIGN PAGE 2.
License
F
o
o
Eye Test
Pass
Corrective Lens
D
DJ
E
M
MJ
NCDL-C
O
Class
R
Restrictions
AM
CL
DP
IL
Special
O
Conditions
LR
NF
RL
F
F
Exp. Date
Proof Submitted
Stop/Response
Validation Number
I
o
o
C
Birth Certificate
Driver License/ID
o
o
E
Credit Card
Passport
o
o
INS Papers
Image Retrieval
Approved By
Date
Fee
U
o
Social Security Card
S
E
Other:
Office
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