MV-44EDL
(8/13)
New
York
State
Department
of
Motor
Vehicles
/Rs
APPLICATION
FOR
ENHANCED
DRIVER
LICENSE
OR
NON-DRIVER
ID
CARD
Batch
File
No.
(N
I
PLEASE
PRINT
CLEARLY
IN
BLUE
OR
BLACK
INK
I
%:::co:
Thisform
is
also
available
on
DMV
web
site
at:
www.dmv.ny.gov
VETERAN
STATUS
PAGE
1
OF
2
I
LRC
LAM
LRN
LDP
LNO
1
LIS
LIN
POR
PAM
PRN
PDP
(check
any
that
apply):
I
Upgrade
Current
QLearner
Q
ID
Q
Renewal
D
Replacement
DChange
D
NYS
license
in
exchange
for
a
license
from
another
US
Document
to
EDL
Permit
State,
the
District of
Columbia
or
Canadian
Province
VOTER
REGISTRATION
QUESTIONS
I
ImageNo.
1
i:
Check
this
box
if
you
would
like
to
have
“Veteran’
printed
on
the
front
of
your
photo
document.
You
must
present
proof
that indicates
an
honorable
discharge
from
military
service.
For
additional
information,
please
see
form
MV—44.1
EDL
NEW
YORK
STATE
ORGAN
AND
TISSUE
DONATION
______________________________________Dlease
answer
“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,
or
if
you
are
changing
your
address,
would you
like
the
Board
of
Elections
to
be
notified?
i:
YES
-
Complete
Voter
Registration
Application
Section
(Not
necessary
Q
NO
-
I
Decline
to
Register/Already Registered/I
do
not
want
to
notify
if
you
will
be
applying
in
person
at
a
DMV
office).
the
Board
of
Elections
of
my
change
of
address.
_____________________________________________
(You
must
fill
out
the
following
section)
To
enroll
in
the
NYS
Department
of
Health’s
Donate
Life
M
Registry,
check
the
“yes”
box
and
then
sign
and
date
below.
You
are
certifying
that
you
are:
18
years
or
older;
consenting
to
donate
all
of
your
organs
and
tissues
for
transplantation,
research
or
both;
authorizing
DMV
to
transfer
your
name
and
identifying
information
to
DOH
for
enrollment
in
the
Registry;
and
authorizing
DOH
to allow
access
to
this
information
to
federally
regulated
organ
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
from
DOH,
which
will
also
provide
you
an
opportunity
to
limit
your
donation.
You
must
answer
the
followin
9
question:
Would
you
like
to
be
added
to
the
Donate
Life
Registry?
D
Yes
D
Skip
This
Question
,
Donor
Consent
Signature:
____________
Date:
IDENTIFICATION
INFORMATION
Do
you
now
have,
or
did
you
ever
have
a
New
York:
Driver
license
9
i:
Yes
D
No
}
If
“Yes’
enter
the
identification
number
as
it
appears
Learner
permit
9
i:
Yes
D
No
on
the
license,
learnerpermit,
or
non-driver
ID
card.
—‘
Non-driver
ID
Card?
D
Yes
D
No
i:
Check
this
box
to
make
a
$1
voluntary
contribution
to
the
Life.
.
.
Pass
It
On
Trust
Fund.
The
$1
donation
will
be
added
to
your
total
transaction
fee.
A
contribution
to
the
Fund
is
used
for
organ
donation
and
transplant
research
and
educational
projects
promoting
organ and
tissue
donation.
FULL
LAST
NAME
FULL
FIRST
NAME
FULL
MIDDLE
NAME
NYS
DRIVER
LICENSE,
LEARNER
PERMIT,
or
NON-DRIVER
ID
CARD NUMBER
Do
you
have
or
did
you
ever
have
a
driver
license
that
is
valid
or
that
expired
within
the
past
year,
issued
by
another
US
State,
the
District of
Columbia
or
a
Canadian
Province?
D
Yes
D
No
If
“Yes”,
where
was
it
issued?
________________________
Date
of
Expiration:
Type
of
License:
License
ID
No.:
SOCIAL
SECURITY
NUMBER*
(55N)
I
I
I
SUFFIX
DATE
OF
BIRTH
SEX
HEIGHT
EYE
COLOR
_________________________________
Month
Day
Year
Male
Female
Feet
Inches
___
I
I
.
D
D
___
____
__________
*
You
must
provide
your
SSN.
Authority to
collect
your
SSN
is
granted
by
Sections
490.3
and
502
ofthe
Vehicle
and
Traffic
Law.
The
information
will
be
used
only
for
exchange
with
otherjurisdictions,
to
assist
in
verification
of
identity,
and
to
invoke
driver
license
sanctions
pursuantto
V&T
Law
Section
510(4-e).
Your
number
will
not
be
given
to
the
public,
or
appear
on
any
form
or
information
request.
DAY
PHONE
NO.
(Optional)
Area
Code
ADDRESS
WHERE
YOU
GET
YOUR
MAIL
-
Include
Street
Number
and
Name,
Rural
Delivery
and/or
box
number
(lfPO
Box,
also
fill
in
“Address
Where
You
Live”
below)
Apt.
No.
city
or
Town
State
Zip
code
county
ADDRESS
WHERE
YOU
LIVE
REQUIRED
IF
DIFFERENT
FROM
MAILING
ADDRESS
-
DO
NOT
GIVE
P0.
BOX.
THIS
ADDRESS
WILL
APPEAR
ON
YOUR
DRIVER LICENSE.
OTHER
CHANGE:
Apt.
No.
city
or
Town
State
Zip
Code
County
Has
your
name
changed?
D
Yes
D
No
Has
your
mailing
address
changed?
Has
the
address
where
you
live
changed?
D
Yes
D
No
lf”Yes”,printyourformernameexactlyasit
DYes
DNo
What
is
the
change
and
the
reason
for
it
appears
on
yourpresentlicense
ornon-driveriD
card.
(new
license
class,
wrong
date
of
birth,
etc.)?
PLEASE
COMPLETEAND
SIGN
PAGE
2.
H
Other
I
I
I
License
I
A
B C
NCDL-C
D
DJ
.
Restrictions
I
I
-
Endorsements
I
I
I
I
I
I
I
Class
E
io
Ni
MJ
.
I
i
I
Special
AM
PP
DP
LR
P1
LS
BC
Conditions
I
Vehicle
Restrictions
I
I
I
I
I
I
I
ML
NF
UC
UP
UR
x8
xT
STOP/RESPONSE
I
Proof
Submitted:
Q
Birth
Certificate
EJ
Driver
License/ID
D
MV-45
Approved
By
Date
D
Failed
to
answer
summons
D
TEENS
D
Passpod
D
Learner
Permit
D
INS
Papers
D
Credit
Card
i:
Insurance
lapse
D
Image
Retrieval
D
Social
Security
Card
D
Medical
Certificate
(CDL
Only)
Office
D
License/Permit
Surrendered
for
Non-Driver
1D
Card
Other
NEW
YORK
STATE
VOTER
REGISTRATION
APPLICATION
nii
fill
this
out
if
you
want
to
register
to
vote
or
change
your
address
or
other
information
with
the
Board
of
Elections.
If
you
register
to
vote,
your
completed
voter
registration
application
will
be
sent
directly
to
the
Board
of
Elections.
If
you
decline
to
register,
your
decision
will
remain
confidential.
You
will
be
notified
by
your
County
Board
of
Elections
when
your
voter
registration
application
has
been
processed.
Are you
a
citizen
of
the
U.S.?
D
Yes
D
No
Will
you
be
1
8
years
of
age
or
older
on
or
before
election
day?
D
Yes
D
No
Telephone
Number
(optional)
If
you
answer
NO,
you
cannot
register
to
vote
Ifyou
answer
NO,
you
cannot register
to
vote
unless
you
will
be
18
by the
end
of
the
year.
Have
you
voted
before?
Voting
information
that
Your
name
was
Your
state
or
NYS
i:
Yes
i:
No
has
changed:
County
was:
What
Year?
skip
if
this
has
not
changed
or
Your
address
was
you
have
not
voted
before.
Political
Party
You
must
make
I
selection
To
vote
in
a
primary
election,
you
must
be
enrolled
in
one
of
these
listed
parties
-
except
the
Independence
Party,
which
permits
non-enrolled
voters
to
participate
in
certain
primary
elections.
i:
Democratic
party
r:
Republican
party
I:
Conservative
party
i:
Working
Families
party
i:
Independence
party
i:
Green
party
i:
Other
(write
in)
_________________
i:
do
not
wish
to
enroll
in
a
party
AFFIDAVIT:
I
swear
or
affirm
that
.
I
am
a
citizen
of
the
United
States.
.
I
will
have
lived
in
the
county,
city,
or
village
for
at
least
30
days
before
the
election.
.
I
meet
all
requirements
to
register
to
vote
in
New
York
State.
.
This
is
my
signature
or
mark
on
the
line
below.
.
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
jailed
for
up
to
four
years.
Date
MV-44EDL
(8/13)
Sign
X
MV-44EDL
(8/13
PAGE
2
OF
2
.
change
the
name
or
address
on
your
voter
registration
InformaciOn
en
español:
si
Ic
interesa
obtener
este
forrnuhirio
de
registro
dcl
votante
en
espanoh
Ilarne
al
1-8OO367-8683
G1:
4A1T
18OO-367-8683
DRIVER
LICENSE
and
LEARNER
PERMIT
APPLICANTS
ONLY
1
.
Have
you
had
a
driver
license,
learner
permit,
or
privilege
to
operate
a
motor
vehicle
suspended,
revoked
or
cancelled,
or
an
application
for
a
license
denied
in
this
state
or
elsewhere,
in
this or
any
other
name?
D
Yes
D
No
If
“Yes”,
has
your
license,
permit
or
privilege
been
restored,
or
your
application
approved?
D
Yes
D
No
2.
Have
you
had,
or
are
you
currently receiving
treatment
or
taking
medication
for
any
condition
which
causes
unconsciousness
or
unawareness
such
as
convulsive disorder,
epilepsy,
fainting
or
dizzy
spells,
or
heart
ailment?
D
Yes
D
No
If
“Yes”,
you
and
your
doctor
must
complete
form
MV-80U.
1,
even
ifyou
have
been
released
from
the
Medical
Review
Program.
This
form
can
be
obtained
at
any
Motor Vehicles
office
or
at
www.dmv.ny.qov.
3.
Do
you
need
a
hearing
aid or
full
view
mirror
while
operating
a
motor
vehicle?
D
Yes
D
No
4.
Have
you
lost
use
of
a
leg,
arm,
hand
or
eye?
D
Yes
D
No
4a.
If
you
are
renewing
your
license
and
answered
“Yes”, is
this
a
new
condition
since
your
last
license?
D
Yes
D
No
4b.
If
you
answered
“NO”
to
4a,
has
your
condition
worsened
since
your
last
license?
D
Yes
D
No
PARENTIGUARDIAN
CONSENT
Teen
Electronic
Event
Notification
Service
(TEENS)
COMMERCIAL
DRIVER
LICENSE
APPLICANTS
ONLY
(Relationship
to
Applicant)
_______________________________
i:
Junior
License
D
Non-driver
ID
Card
(under
16)
I
am
the
parent
or
guardian
of
the
applicant,
and
I
consent
to
the
issuance
of
a
learner
permit,
license
or
(if
under
16)
a
non-driver
ID
card
to
him/her.
I
understand
that
I
am
responsible
for
certifying
that
the
applicant
has
completed
at
least
50
hours
of
supervised
“practice”
driving,
including
15
hours
of driving
after
sunset,
prior to
the applicant
taking
a
road
test,
and
that
this certification
(MV-262)
must be
presented
at
the
time
of
the
road
test.
Note
to
parent/guardian:
lfthe
driver
license
applicant
is
1
7
years
old
and
has
a
Driver
Education
Student
Certificate
of
Completion
(MV-285),
consent
is
not
required.
Parent
or
Guardian
Sign
Here
___________________________________________________________
________________________________
1
(Date)
I
would
like
to
enroll
in
the
TEENS
program
to
be
notified
if
the under
18
year-old
applicant
NYS
Client
ID
of
Consenting
Parent
or Guardian
Above-
Required
receives
a
conviction,
suspension,
revocation
or
an
accident
on
their
license
file.
For
more
information
about
this
program,
see
form
MV-i
046,
How
to
Enroll
in
TEENS
or
MV-1056,
TEENS
FAQs.
This
is
a
FREE
service.
I In
the
past
I 0
years,
was
a
driver
license
issued
to
you
from
another
state
in
the
U.S.
or
the
District
of
Columbia
?
D
Yes
0
No
If
YES,
write
the
name
of
each
one
(ifyou
turn
in
a
license
from
another
state,
do
not
include
that
state):
2.
You MUST
certify
to
DMV
that
you
operate
(or
expect
to
operate)
a
CMV in
one
of
the
following
four
driving
types
(select
only one):
i:
Non-excepted
Interstate
(NI)
-
certified
medical
status
required.
(Age
21
or
older;
operate/expect
to
operate
Interstate)
i:i
Non-excepted
Intrastate
(NA)
-certified
medical
status
required.
(.4ge
18
or
older:
opeiate/eipect
to
operate
in
!‘/YS
only:
lutist
hair
K
restriction)
i:i
Excepted
Interstate
(El)
—
(Age
18
ni
ok/er;
operale/erprs’t
to
operate
Excepted
Operation
Oh/c;
lillist
hai’e
A3
restriction)
0
Excepted
Intrastate
(EA)
-
(Age
18
or
ok/er:
oJ)cis!tc/cvpect
to
O/)crcltc
Excepted
Operation
Oiil
and
in
N}’S
On/c;
onisi
hai’e
A3
aiid
K
restriction)
If
the
driving
type
you
selected
requires
certified
medical
status
(NI
or
NA)
you
must
provide
a
legible
copy
of
your
current
USDOT
Medical
Examiner’s
Certificate
to
DMV
if
it
is
not
already
on
file.
Please
see
DMV
form
MV-44.
5
if
additional
information
is
needed
to
help
you
determine
your
driving
type.
CERTIFICATION
_________________
I
certify
that
the
information
I
have
given
on
this
application
is
true.
I
certify
that
I
am
a
citizen
ofthe
United
States
ofAmerica
and
a
resident
of
New
York
State.
If
I
am
applying
for
a
replacement
license
or
non-driver
identification
card,
I
certify
that the
license
or
nondriver
identification
card
has
been
lost,
stolen
or
mutilated
and
that,
if
the
lost
license
or
non-driver
identification
card
is
found,
I
will
turn
it
in
to
the Department
of Motor
Vehicles.
If
I
am
exchanging
my
out-of-state
license
for
a
NYS
license,
I
certify
that
I
was
a
permanent
resident
of
the
state
or
province
in
which
my
license
was
issued
at
the
time
the
license
was
issued,
that
such
license
has
been
valid
for
at
least
6
months,
and that
I
have
not
failed
a
road
test
in
NYS
in
the
last
i2
months.
If
I
am
a
male
at
least
i8
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.
I
understand
that
the
information
and
documentation
that
I
have
provided
in
connection
with
this
application
will
be
used
to
verify
my
identity,
New
York
State
residency
and
United
States
citizenship.
I
understand
that
this
information
and
documentation
will
be
shared
with
the
New
York
State
and
United
States
federal
entities
for
these
verification
purposes
and
I
consent
to
this
dissemination and
use.
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.
SIGN
HERE
I
PLEASE
J
NAMEê
CREDIT
CARD
AUTHORIZATION
IF
CARDHOLDER
IS
NOT
THE
APPLICANT:
Sign
My
signature
authorizes________________________________________________
Here
to
use
my
credit
card
for
payment
of
any
fees
in
connection
with
this
application
and
I
understand
that
I
must
be
present
for
this
transaction.
I
I
(Cardholder-Sign
Name
in
Full)
TEST
Applicant’s
Signature
Examiner’s
Initials
I
Eye
D
Pass
D
Corrective
Lens
I
Written
D
Pass
0
Fail
2
OFFICE
OSE
ONLY
MV-44EDL
(8/13)
NEW
YORK
STATE
VOTER
REGISTRATION
APPLICATION
INFORMATION
(Please
read
before
you
complete
application
on
the
other
side.)
Use
the
NYS
Voter
Registration
Application
to
Register
to
Vote
in
NYS
Elections,
and/or:
.
become
a
member
of
a
political
party
•
change
your party
membership
To
Register
You
Must:
•
be
a
U.S.
citizen;
•
be
1
8
years
old
by
the
end
ofthis
year;
•
not
be
in
prison
or
on
parole
for
a
felony
conviction;
•
not
claim
the
right
to
vote
elsewhere
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1-800-367-8683
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-
367-8683
If
you
decline
to
register,
your
decision
will
remain confidential.
If
you believe
that
someone
has
interfered
with your
right
to
register
or
decline
to
register
to
vote,
your
right
to
privacy
in
deciding whether
to
register
or
in
applying
to
register
to
vote,
or
your
right
to
choose
your
own
political
party
or
other
political
preference,
you
may
file
a
complaint
with
the
NYS
Board
ofElections,
40
Steuben
Street,
Albany,
NY
12207-2109
(phone:
1-800-469-6872).
Your
completed
application
will
be
sent
to
the
Board
of
Elections
and
you
will
be
notified
by
your
County
Board
of
Elections
when
your
application
has
been
processed.
If
you have
any
questions
about
filling
out
the
voter
registration
application
or
registering
to
vote,
you
should
call
your
County
Board
of
Elections
or
call
I
-800-FOR-VOTE
(TDD/TTY
Dial
711)
(only
for
voter
registration
questions).
Ifyou
live
in
New
York
City,
you
should
call
1-866-VOTE-NYC.
You
may
also
find
answers
or
tools
at
the
NYS
Board
of
Elections
website:
www.elections.ny.gov
