Ds 872 Form PDF Details

Ds 872 form is a document used to request an exemption from the Internal Revenue Service (IRS) for a person or organization. The form can be used to apply for exemption from federal income tax, estate and gift tax, and certain excise taxes. The deadline to file the Ds 872 form is typically April 15th of each year, although the date may vary depending on your specific situation. Make sure to consult with an accountant or tax professional if you have any questions about whether you should file a Ds 872 form.

QuestionAnswer
Form NameDs 872 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesds872 19a form, ds record 19, ds annual 19, nys dmv ds 872

Form Preview Example

CARRIER’S ANNUAL REVIEW OF EMPLOYEE’s

DRIVING RECORD UNDER ARTICLE 19-A

DRIVER INFORMATION

Driver’s Last Name

First

 

M.I.

Date of Birth (Month/Day/Year)

 

 

 

 

 

 

 

 

License ID Number

 

State

Class of Driver’s License

Endorsements

 

Restrictions

Expiration Date

(from Driver License)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CARRIER INFORMATION

Carrier/DBAName

Federal ID Number

19-ABusiness ID Number

Legal Name (if different)

Were you involved in ANY motor vehicle accident(s) during the past 12 months that do not appear on your abstract? YES NO If YES, completeAccident Information section below:

ACCIDENT INFORMATION (ifadditionalspaceisneeded,usethebackofthisform)

Date

 

of

Location

Accident

City, State, Zip Code, County

 

 

Briefly describe property damage, type of vehicle involved and

approximate dollar value of damage for each vehicle

Number of

People

Injured

Were there

any fatalities?

YES or NO

Were you convicted of ANY traffic violation(s) (other than parking) or any crime(s) during the past 12 months that do not appear

on your abstract? YES

NO If YES, complete Record of Convictions section below:

 

RECORD OF CONVICTIONS (ifadditionalspaceisneeded,usethebackofthisform)

 

Date of

Date of

Of What Charge

Type of

 

Court Location

Violation

Conviction

Were You Convicted?

Motor Vehicle Operated

 

City, State, Zip Code, County

 

 

 

 

 

 

 

 

 

CMV

 

 

 

 

 

Non-CMV

 

 

 

 

 

CMV

 

 

 

 

 

Non-CMV

 

 

 

 

 

CMV

 

 

 

 

 

Non-CMV

 

 

DRIVER CERTIFICATION

I certify that the information above is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months, and accidents I was involved in during the past 12 months. If no violations or accidents are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months, or have been involved in any accidents during the past 12 months that is not already listed on my license abstract.

X

(Driver Signature)

(Date)

CARRIER CERTIFICATION

I have compared the information given by the driver with the attached driver’s abstract of operating record. I have ensured that all accident and conviction details not appearing on the driver’s abstract are listed on this form. I HAVE ATTACHED THE DRIVER’S

ABSTRACT(S),WHICH MUST BE DATED WITHIN 30 DAYS PRIOR TO THE DATE OF THIS INTERVIEW.

I interviewed this employee and certify that this driver meets the standards for safe driving, has been instructed in, and is in compliance with, the provisions ofArticle 19-A, and is qualified to drive a bus.

 

(Print Name of Carrier Representative)

 

 

(Title)

X

 

 

 

 

(Authorized Signature of Carrier Representative)

 

 

(Date of Interview)

DS-872 (5/16)

dmv.ny.gov

reset/clear

 

 

 

 

How to Edit Ds 872 Form Online for Free

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Step 1: First, access the tool by pressing the "Get Form Button" above on this page.

Step 2: With our handy PDF tool, you can accomplish more than simply fill out blanks. Edit away and make your documents appear high-quality with customized textual content put in, or adjust the original content to excellence - all supported by the capability to incorporate just about any images and sign the PDF off.

Completing this form requires attentiveness. Make sure that all mandatory areas are done properly.

1. To start off, while filling in the nys dmv form ds 872, start out with the page that includes the following blanks:

Filling in section 1 of ds 872 a pdf

2. Just after filling in the last step, go to the next stage and fill in the essential particulars in these blank fields - Date of Violation, Date of Conviction, Of What Charge, Were You Convicted, Type of, Court Location, Motor Vehicle Operated, City State Zip Code County, CMV NonCMV CMV NonCMV CMV, DRIVER CERTIFICATION, I certify that the information, Driver Signature, Date, and CARRIER CERTIFICATION I have.

Writing segment 2 in ds 872 a pdf

A lot of people frequently make some mistakes while completing Motor Vehicle Operated in this part. Ensure you double-check whatever you type in right here.

3. Completing I interviewed this employee and, Print Name of Carrier, Title, Authorized Signature of Carrier, dmvnygov, Date of Interview, and resetclear is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Filling out part 3 in ds 872 a pdf

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