Form Ds-115 - Request For Nys Driving Privileges
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1REQUEST FOR NYS
DRIVING PRIVILEGES
To request clearance for New York State driving privileges, please provide the information below and include
the appropriate non-refundable fee as follows:
Due to a fee increase effective August 18, 2017, the fee you are required to pay is based on the date your
request is processed:
The fee is $25 for requests processed no later than August 17, 2017.
●
The fee is $100 for requests processed on or after August 18, 2017, no exceptions can be made.
●
NOTE: Effective August 18, 2017 DMV will no longer be able to accept the $25 fee.
To avoid a delay in
processing your application, please consider the mailing time and submit the correct fee amount when mailing
your application.
Full Last Name
Full First Name
MI
Date of Birth (mm/dd/yy)
Sex
Daytime Phone Number (Area Code) - (Optional)
(
)
-
M
F
/
/
NYS Driver License, Learner Permit or Non-Driver ID Card Number (if available)
CURRENT OUT-OF-STATE RESIDENCE ADDRESS
Number and Street
Apt. Number
City or Town
State
Zip Code
MAILING ADDRESS IF DIFFERENT THAN RESIDENCE
Number and Street
Apt. Number
City or Town
State
Zip Code
X
Signature (required)
(Sign name in full)
Date
You must pay the appropriate fee with a check or money order made payable to “Commissioner of Motor
Vehicles.” Mail your payment and this completed form to:
NYS Department of Motor Vehicles
6 Empire State Plaza, Room 336
Albany, NY 12228
Attention: Driver Improvement Unit
Reset/Clear
Clear
DS-115 (6/17)
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