Form Mv-44cr - Restricted Use Or Conditional Driver License Application Page 2
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31. Have you had, or are you currently receiving treatment or taking medication for any condition which causes unconsciousness or unawareness such as
o
o
convulsive disorder, epilepsy, fainting or dizzy spells, or heart ailment?
Yes
No
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 dmv.ny.gov.
o
o
2. Do you need a hearing aid and/or full view mirror while operating a motor vehicle?
Yes
No
o
o
3. Have you lost use of a leg, arm, hand or eye?
Yes
No
o
o
3a. If you are renewing your license and answered “Yes”, is this a new condition since your last license?
Yes
No
o
o
3b. If you answered “NO” to 3a, has your condition worsened since your last license?
Yes
No
CERTIFICATION - I certify that the information I have given on this application is true. If I am applying for a replacement license, I certify that
the license has been lost, stolen or mutilated and that, if the lost license is found, I will turn it in to the Department of Motor Vehicles. I will
pay the full tuition and other required fees for the rehabilitation program (if applicable), attend the program (if required), and will drive within
the conditions required for the restricted or conditional license. I understand that failure to do so will result in the revocation of my restricted
or conditional license, and the reinstatement of the suspension or revocation against my full license. 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.
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DATE:
SIGN HERE
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PLEASE PRINT NAME
HOW TO APPLY FOR A RESTRICTED USE OR CONDITIONAL DRIVER LICENSE
Follow the instructions below that apply to you. You must apply in person. You can do this at most, but not all, Motor Vehicles offices. Contact the nearest office to
find out where you can apply.
TO APPLY
1. Complete both sides of this application and sign your name in the “Certification” box.
for a
2. Present this application and proof of identity. Refer to form ID-44 “Proofs of Identity” for a list of acceptable documents that you can show for proof.
restricted
3. Complete the Restricted Use License Attachment (form MV-693) or the Conditional License Attachment (form MV-2020) if applicable, or any
use or
additional forms provided by the Motor Vehicles office.
conditional
license
4. Pay the appropriate fee.
TO REPLACE
1. Complete both sides of this application and sign your name in the “Certification’ box. Your name, date of birth and sex must be entered
your restricted
exactly as they were shown on your last license.
use or
2. Present this application, and proof of identity. Refer to form ID-44 “Proofs of Identity” for a list of acceptable documents that you can show for
conditional
proof. To replace a mutilated license, turn in the license with this application.
license
3. Pay the appropriate fee.
4. If your Restricted Use License Attachment (form MV-693) or Conditional License Attachment (form MV-2020) is lost, you must complete a
new attachment.
TO CHANGE
1. Complete both sides of this application (use your new information), and sign your name in the “Certification” box.
information
2. Present this application, your current license, your Restricted Use License Attachment (form MV-693) or Conditional License Attachment
on your
(form MV-2020), proof of identity, and proof of the change that you need. Refer to form ID-44 “Proofs of Identity” for a list of acceptable
restricted use
documents that you can show for proof.
or conditional
license
3. Pay the appropriate fee.
1. Complete both sides of this application, and sign your name in the “Certification” box.
TO RENEW
your restricted
2. Present this application, the Restricted Use License Attachment (form MV-693) or Conditional License Attachment (form MV-2020),
use or
your current license, and proof of identity. Refer to form ID-44 “Proofs of Identity” for a list of acceptable documents that you can show for proof.
conditional
license
3. Take a vision test in any Motor Vehicles office or have your vision tested by one of the following providers: licensed physician, physician
assistant, registered nurse, nurse practitioner, ophthalmologist, optometrist, optician, pharmacists who are enrolled in DMV’s Vision Registry, staff
supervised by any of these providers and the staff of organizations that are authorized by the New York State DMV to give the vision test.
4. Pay the appropriate fee.
PAGE 2 OF 3
MV-44CR (09/17)
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