Form Mv-232 (5/15) - Address Change Form Page 2
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1
2**ADDRESS CHANGE**
PAGE 2 OF 2
Change your address online at
MV-232 (5/15)
PART 1 - Complete this section to CHANGE YOUR ADDRESS
Mark the box for each type of document that you have and that must be changed to show your new address.
o
o
o
State (not Enhanced) License/Permit/Non-Driver ID Card
Enhanced License/Permit/non-Driver ID Card
Registration
Provide the information in Part 1 that applies to the type of document that you want to update.
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
IMPORTANT:
o
new address on your voter registration record, mark this box:
. If you do not mark the box, your new address will be sent to the Board of Elections of your
county of residence.
LICENSE/PERMIT/NON-DRIVER ID CARD:
SEX
DATE OF BIRTH
Year Document Expires
Enter the identification number as it is printed
o
o
M
F
on your license, permit or non-driver ID card
NAME (Print your name exactly as it is printed on the license, permit or non-driver ID card)
NEW ADDRESS - WHERE YOU GET YOUR MAIL (Required - Include Street No. and Name, Rural Delivery, Apt. No., and/or P.O. Box No. Also fill in residence address below.)
STATE
ZIP CODE
COUNTY
CITY OR TOWN
NEW ADDRESS – WHERE YOU LIVE (Required - Include Street No. and name, and Apt. No.)
STATE
ZIP CODE
COUNTY
CITY OR TOWN
PREVIOUS NYS ADDRESS (Include Street No. and Name, Rural Delivery, Apt. No., and/or Box No.)
CITY OR TOWN
COUNTY
REGISTRATION: Provide the information below for each registration in your name.
License Plate No.
Type of Registration (Mark One)
License Plate No.
Type of Registration (Mark One)
o
o
o
o
o
o
Passenger
Commercial
Snowmobile
Passenger
Commercial
Snowmobile
o
o
o
o
Boat
Other (Specify)_______________
Boat
Other (Specify)_______________
o
o
o
o
o
o
Passenger
Commercial
Snowmobile
Passenger
Commercial
Snowmobile
o
o
o
o
Boat
Other (Specify)_______________
Boat
Other (Specify)_______________
CERTIFICATION: I certify that I am the individual named above and that the information provided is true to the best of my knowledge.
-
:
Sign Here
______________________________________________________________________________
_______________________________
Sign Name in Full
Date
WARNING! Knowingly providing false information on this form is a misdemeanor and will result in penalties authorized by law.
Mark the box for each type of document that you currently have and want to update to show your new address. Then, write a check that has the
account holder’s name pre-printed or a money order payable to “Commissioner of Motor Vehicles” for the total fee.
PART 3 NEW YORK STATE VOTER REGISTRATION APPLICATION
Complete this application if you want to register to vote or update your voter registration information with the Board of Elections.
o
o
o
o
Telephone Number (optional)
Are you a citizen of the U.S.?
Yes
No
Will you be 18 years of age or older on or before election day?
Yes
No
If you answer NO, you cannot register to vote unless you will be 18 by the end of the year.
If you answer NO, you cannot register to vote
Have you voted before?
Voting information that
Your name was
Your state or NYS
o
o
Yes
No
has changed:
County was:
Your address was
skip if this has not changed or
What Year?
you have not voted before.
Political Party
AFFIDAVIT: I swear or affirm that
I wish to enroll in a political party:
o
l
You must make 1
I am a citizen of the United States.
Democratic party
o
selection To vote in a
l
I will have lived in the county, city, or village for at least 30 days before the election.
Republican party
o
primary election, you
l
I meet all requirements to register to vote in New York State.
Conservative party
o
must be enrolled in one
l
This is my signature or mark on the line below.
Green party
o
of these listed parties -
l
The above information is true, I understand that if it is not true, I can be convicted and fined up to $5,000 and/or
Working Families party
o
except the Independence
jailed for up to four years.
Independence party
o
Party, which permits
Women’s Equality party
non-enrolled voters to
o
Reform party
participate in certain
o
_________________
Other
primary elections.
I do not wish to enroll in a political party
X
o
Sign
Date
No party
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