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NEW YORK STATE ORGANAND TISSUE DONATION

MV-44EDL (10/11)	New York State Department of Motor Vehicles
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
IAMAPPLYING FORAN ENHANCED	(check any that apply):

PAGE 1 OF 3

Batch File No.

Image No.

LRC	LAM	LRN	LDP	LNO
LIS	LIN	POR	PAM	PRN PDP


oUpgrade Current oLearner oID		o	Renewal	o	Replacement	o	oNYSlicenseinexchangeforalicensefromanotherUS
DocumenttoEDL Permit	card		Renewal		Replacement	Change		State,theDistrictofColumbiaorCanadianProvince
DocumenttoEDL Permit								State,theDistrictofColumbiaorCanadianProvince


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								oYES - Complete Voter RegistrationApplication Section
you are changing your address, would you like the Board of Elections to be notified?								oNO-IDeclinetoRegister/AlreadyRegistered/Idonotwant
NOTE:If you do not check either box, you will be considered to have decided not to register to vote.								tonotifytheBoardofElectionsofmychangeofaddress.

SIGN BELOW ♥to enroll in the NYS Department of Health’s Donate LifeSM 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 aconfirmationletterfromDOH,whichwillalsoprovideyouan opportunitytolimityourdonation.

♥Donor Consent Signature: ➧____________________________________________________ Date:_____________

oCheck this box to make a $1voluntary contribution to the Life...Pass It On Trust Fund. The $1 donation will be added to your total transaction fee. Acontribution to the Fund is used for organ donation and transplant research and educational projects promoting organ and tissue donation.

IDENTIFICATION INFORMATION

Do you now have, or did you ever have a New York:

NYS DRIVER LICENSE, LEARNER PERMIT, or

Driver license? . . . . . oYes

oNo

If “Yes”, enter the identification number as it appears

NON-DRIVER ID CARD NUMBER

Learner permit? . . . . oYes

oNo

} on the license, learner permit, or non-driver ID card.

Non-driver ID Card? oYes

oNo

FULL LAST NAME

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

FULL FIRST NAME

District of Columbia or a Canadian Province? oYes oNo

If “Yes”, where was it issued? ____________________________

FULL MIDDLE NAME		Date of Expiration:		Type of License:

License ID No.:

SUFFIX	DATE OF BIRTH
	Month	Day	Year

SEX

Male Female

o o

HEIGHT

Feet Inches

EYE COLOR

DAY PHONE NO. (Optional)

Area Code

()

SOCIALSECURITYNUMBER*(SSN) *YoumustprovideyourSSN.AuthoritytocollectyourSSNisgrantedbySections490.3and502oftheVehicleandTrafficLaw.

The information will be used only for exchange with other jurisdictions, to assistinverification

of identity, and to invoke driver license sanctions pursuant to V&TLaw Section 510(4-e).Your

number will not be given to the public, or appear on any form or information request.

ADDRESS WHEREYOU GETYOUR MAIL - Include Street Number and Name, Rural Delivery and/or box number (If PO Box, also fill in “Address WhereYou Live” below)

	Apt. No.	City or Town	State	Zip Code	County


ADDRESS WHEREYOU LIVE REQUIRED IFDIFFERENT FROM MAILINGADDRESS - DO NOT GIVE P.O. BOX. THISADDRESS WILLAPPEAR ONYOUR DRIVER LICENSE.
	Apt. No.	City or Town	State	Zip Code	County

Has your name changed? oYes oNo

Has your mailing address changed?

Has the address where you live changed? oYes oNo

If “Yes”, print your former name exactly as it

oYes oNo

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 COMPLETEAND SIGN PAGE 2.

Other

License

NCDL-C

Restrictions

Class

Endorsements

Special

RestrictionsVehicle

Conditions

STOP/RESPONSE

Proof Submitted: oBirth Certificate

oDriver License/ID

oMV-45

Approved By

Date

oFailed to answer summons

oTEENS

oPassport oLearner Permit

oResidency

oCredit Card

oInsurance lapse

oImage Retrieval oSocial Security Card oMedical Certificate (CDL only) Office

Other:

EoLicense/Permit Surrendered for Non-Driver ID Card

PARENT/GUARDIAN CONSENT


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

oJunior License oNon-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: If the driver license applicant is 17 years old and has a Driver Education Student Certificate of Completion (MV-285), consent is not required.

Parent or Guardian

Sign Here ➧

Teen Electronic Event Notification Service (TEENS)

I would like to enroll in the TEENS program to be notified if the under 18 year-old applicant receives a conviction, suspension, revocation or an accident on their license file. For more information about this program, see form MV-1046, How to Enroll in TEENS or MV-1056, TEENS FAQs. This is a FREE service.

(Relationship toApplicant)

(Date)

NYSClientIDofConsentingParentorGuardianAbove-Required

COMMERCIAL DRIVER LICENSEAPPLICANTS ONLY Please answer questions 1 & 2, below:

1.	Did you have a driver license from the District of Columbia or any US state, otherthanNewYork, in the past 10 years? o Yes o No
	If YES, list the names of all of the states or DC, but if you are turning in a license from another state, do notlist that state:
2.	Do you certify that you comply with federal requirements set forth in 49 CFR Part 391 and have a valid Medical Examiner’s Certificate? o Yes o No
	If YES, you must present your Medical Certificate to prove you meet this standard.
	If NO, will your commercial driving be limited to municipal and/or school operations only? o Yes o No

NOTE: For an explanation of 49 CFR 391 requirements and operations that do not require a Medical Examiner’s Certificate, see form MV-44.5 Federal Requirements for Commercial DriverApplicants.

CERTIFICATION I certify that the information I have given on this application is true. I certify that I am a citizen of the 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 12 months. If I am a male at least 18 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, is a misdemeanor under Section 392 of the Vehicle and Traffic Law, and may result in the revocation or suspension of your license or non-driver ID card.

SIGN HERE ➧

PLEASE

NAME ➧

CREDIT CARDAUTHORIZATION IF CARDHOLDER IS NOT THEAPPLICANT:

My signature authorizes____________________________________________

Sign

Here ➧

to use my credit card for payment of any fees in connection with this application and I

(Cardholder-Sign Name in Full)

understand that I must be present for this transaction.

TEST RESULTS

Applicant’s Signature

Examiner’s Initials

Eye

o Pass

o Corrective Lens

Written

o Pass

o Fail

PAGE 3 OF 3


MV-44EDL (10/11)	NEW YORK STATE VOTER REGISTRATIONAPPLICATION INFORMATION		OFFICE USE ONLY
	(Please read before you complete application on the other side.)
You Can Use This Form To:		To Register You Must:
You Can Use This Form To:		To Register You Must:
register to vote in New York State		be a U.S. citizen

	change your name and/or address, if there is a change since you voted	be 18 years old by December 31 of the year in which you file this form
	enroll in a political party or change your enrollment
	enroll in a political party or change your enrollment	(note: you must be 18 years old by the date of the general, primary or

		other election in which you want to vote.)
		live in the county, city, or village, at least 30 days before an election
		not be in jail or on parole for a felony conviction
		not claim the right to vote elsewhere

If you would like help in filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application form in private.

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 of Elections, 40 Steuben Street,Albany, NY 12207-2109, Phone 1-800-469-6872.

If you have any questions about registering to vote, you should call your County Board of Elections or call 1-800-FOR-VOTE (only for Voter Registration questions). If you live in New York City, you should call 1-212-VOTE-NYC. Hearing impaired people with TDD may call 1-800-533-8683. You may also log on to our website for information at: www.elections.state.ny.us

NEW YORK STATE VOTER REGISTRATIONAPPLICATION - (Fill out this part only if you want to register to vote or change your address or other information with the Board of Elections, and if you are also filling out the DMV application above.)

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 U.S. citizen? o Yes

o No

I will be 18 years old on or before election day:

o Yes o No

Home Telephone Number (optional)

If you answered NO, do not complete this form.

If you answered NO, do not complete this form, unless you will be 18 by the end of the year.

Area Code

(

)

Last year voted

YourAddress was (give house number, street, and city)

In county/state

Under the name (if different from your name now)

Choose a Party – Check one box only

AFFIDAVIT: I swear or affirm that

o DEMOCRATIC PARTY

Please note: In order

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.

o REPUBLICAN PARTY

to vote in a primary

I meet all requirements to register to vote in New York State.

election, you must be

o CONSERVATIVE PARTY

This is my signature or mark on the line below.

enrolled in a party.

o WORKINGFAMILIESPARTY

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

*Except the Independence

jailed for up to four years.

o INDEPENDENCE PARTY*

Party which permits non-

↓ Signature or mark

↓

o GREEN PARTY

enrolled voters to vote in

their primary election.

o OTHER(writein) _______________________

o I DO NOT WISH TO ENROLL INAPARTY

Date

MV-44EDL (10/11)

Question	Answer
Form Name	Form Mv 44Edl
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	SSN, mv44 pdffiller, mv44 form, suffix drivers license

Form Mv 44Edl – Fill Out and Use This PDF

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