New York > Statewide > Department Of Motor Vehicles
Application For Enhanced Driver License Or Non-Driver ID Card MV-44EDL - New York
| Application For Enhanced Driver License Or Non-Driver ID Card Form. This is a New York form and can be used in Department Of Motor Vehicles Statewide . |
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MV-44EDL (10/11) New York State Department of Motor Vehicles PAGE 1 OF 3 Batch File No. Image No. LRC LIS LIN LAM LRN LDP LNO POR PA M PRN PDP APPLICATION FOR ENHANCED DRIVER LICENSE OR NON-DRIVER ID CARD PLEASE PRINT CLEARLY IN BLUE OR BLACK INK. This form is also available on DMV's web site at: www.dmv.ny.gov I AM APPLYING FOR AN ENHANCED (check any that apply): o Upgrade Current oLearner o ID o Renewal o Replacement oChange o NYS license in exchange for a license from another US card State, the District of Columbia or Canadian Province Document to EDL Permit VOTER REGISTRATION QUESTIONS (Please answer "yes" or "no".) 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? NOTE: If you do not check either box, you will be considered to have decided not to register to vote. oYES - Complete Voter Registration Application Section oNO - I Decline to Register/Already Registered/I do not want to notify the Board of Elections of my change of address. NEW YORK STATE ORGAN AND TISSUE DONATION SIGN BELOW to enroll in the NYS Department of Health's Donate Life SM Registry. By signing, you are certifying that you are: 18 years of age 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 letter from DOH, which will also provide you an opportunity to limit your donation. o 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. Donor Consent Signature: ç ____________________________________________________ Date:_____________ Driver license? . . . . . o Yes Learner permit? . . . . o Yes Non-driver ID Card? o Yes FULL LAST NAME IDENTIFICATION INFORMATION Do you now have, or did you ever have a New York: o No o No o No } If "Yes", enter the identification number as it appears on the license, learner permit, or non-driver ID card. ¦ 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 FULL FIRST NAME that expired within the past year, issued by another US State, the District of Columbia or a Canadian Province? o Yes Date of Expiration: Type of License: o No If "Yes", where was it issued? ____________________________ FULL MIDDLE NAME License ID No.: SUFFIX DATE OF BIRTH Month Day Year SEX Male HEIGHT Female EYE COLOR DAY PHONE NO. (Optional) Area Code ( ) o o Feet Inches SOCIAL SECURITY NUMBER* (SSN) * You must provide your SSN. Authority to collect your SSN is granted by Sections 490.3 and 502 of the Vehicle and Traffic Law. The information will be used only for exchange with other jurisdictions, to assist in verification of identity, and to invoke driver license sanctions pursuant to V&T Law Section 510(4-e). Your number will not be given to the public, or appear on any form or information request. ADDRESS WHERE YOU GET YOUR MAIL - Include Street Number and Name, Rural Delivery and/or box number (If PO 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 P.O. BOX. THIS ADDRESS WILL APPEAR ON YOUR DRIVER LICENSE. Apt. No. City or Town State Zip Code County Has your mailing address changed? Has your name changed? o Yes o No Has the address where you live changed? o Yes o No o Yes o No If "Yes", print your former name exactly as it What is the change and the reason for it OTHER CHANGE: appears on your present license or non-driver ID card. (new license class, wrong date of birth, etc.)? PLEASE COMPLETE AND SIGN PAGE 2. F O R O F F I C E U S E Other Restrictions Endorsements Vehicle Restrictions STOP/RESPONSE Proof Submitted: Special Conditions AM ML NF PP UC DP UP LR UR LS X8 Date BC XT License Class A E B C ID NCDL-C M D MJ DJ o Failed to answer summons o TEENS o Insurance lapse o License/Permit Surrendered for Non-Driver ID Card o Birth Certificate o Driver License/ID o MV-45 o Passport o Learner Permit o Residency o Credit Card o Image Retrieval o Social Security Card o Medical Certificate (CDL only) Other: Approved By Office MV-44EDL (10/11) PAGE 2 OF 3 DRIVER LICENSE and LEARNER PERMIT APPLICANTS ONLY 1. Have you had, or are you being treated for, any of the following, or has a previous disability worsened? o Yes o No If "Yes", check all that apply. o 1. Convulsive disorder, epilepsy, fainting or dizzy spells, or any condition which causes unconsciousness o 2. Heart ailment o 3. Hearing impairment o 4. Lost use of leg, arm, foot, hand, or eye o 5. Other (explain) ___________________________________________________________________________________________________________ If you checked box 1, you and your doctor must complete form MV-80U.1, "Physician's Statement for Medical Review Unit"; if you checked box 2, your doctor must complete form MV-80, "Physician's Statement". These forms can be obtained at any Motor Vehicles office or at www.dmv.ny.gov. If you checked boxes 3, 4 or 5, you must contact a Motor Vehicles office for instructions. 2. 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? o Yes o No If "Yes", has your license, permit or privilege been restored, or your application approved? o Yes o No PARENT/GUARDIAN CONSENT o Junior License o 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
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