Form Mv-1w - Withdrawal Of Consent

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MV-1W (10/07)
New York State Department of Motor Vehicles
WITHDRAWAL OF CONSENT
Check all boxes below that describe the documents that DMV issued. If you have the documents, attach them to this form.
Learner’s Permit (Motorcycle)
Class DJ License
Class MJ License
Learner’s Permit
Name on
Date of Birth
Male
Document
Female
Mailing Address
Apt. #
Client
(Street & Number)
ID No.
City
State
Zip Code
Print Name of Parent of Guardian
I am the parent or guardian who consented to the issuance of a license or learner’s permit to the person named above. By signing this
form, I am advising the Department of Motor Vehicles that I withdraw my consent.
X
(Signature of Parent or Guardian)
(Date)
Return this form, and the documents to be canceled, to a Motor Vehicles office, or send them to the NYS
Department of Motor Vehicles, Driver Improvement Bureau, 6 Empire State Plaza, Albany NY 12228.
"

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