In the form MV65, attorney-in-fact can be granted full authority to execute any and all instruments, documents, affidavits, etc., to effect registration, transfer of title, application for title, or act in the owner's place for the specified motor vehicle or vessel.
The form requires the vehicle owner to provide their legal name, address, and the name and address of the appointed business or individual. The form also requires information about the motor vehicle or vessel, such as title number, year, make, model, vehicle identification number, color, and license plate number. Additionally, the form includes a section for odometer reading information and related statements, if applicable.
The vehicle owner must sign the form and have it notarized. If the purchaser is involved, they should also certify the odometer reading by signing the form. If the applicant is a firm or corporation, the full name should be printed.
Question | Answer |
---|---|
Form Name | Montana Form MV65 |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | mv65, mt vehicle poa |
MV-65 (9/11)
New York State Department of Motor Vehicles
VEHICLE ESCORT DRIVER APPLICATION
PLEASE PRINT WITH BLUE OR BLACK INK IN THE BOXES
|
www.dmv.ny.gov |
|
Note: To become a certified vehicle escort driver, you MUST: |
|
|
Have a valid driver license |
Pay a $40 fee |
Present proof of ID |
Be at least 21 years old |
Pass a written exam |
(as listed on ID-44) |
Action Wanted:
oOriginal Certification |
oRenewal |
oReplace Certificate |
o Amend Certification |
|
|
|
|
Note: If you are a New York licensed driver and need to change your name and/or address, you must notify DMV of any change BEFORE you submit this application to the Bus Driver Unit.
If you are applying for a replacement or need to change your name and/or address on your certificate, complete this form and mail it to: NYS Department of Motor Vehicles, Bus Driver Unit, 6 Empire State Plaza,Room220C,Albany, NewYork12228. A $5.00 check (payabletotheCommissionerofMotorVehicles) is requiredfor a replacement certificate.
If you are applying for a renewal, complete this form and mail it to: Department of Motor Vehicles, 207 Genesee Street, Utica, NY 13501-2874. A $40 check (payable to Commissioner of Motor Vehicles) is required for a renewal.
Name of Applicant (Last, First, Middle)
Phone Number (Include area code) |
Date of Birth |
|
|
||||
|
|
|
|
|
|
|
|
|
|
Month |
Day |
Year |
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State/Province of |
|
driver license |
Driver License Number |
Sex
M F
o o
Height |
|
|
Eye Color |
|
|
|
|
FEET |
INCHES |
|
|
|
|
|
|
Client ID number as it appears on your NYS Vehicle Escort card (if available)
|
Address Where You Get Your Mail (Include Street Number and Name, Rural Delivery, and/or Box) |
|
|
|
|
Apt. # |
|
||||||||||||||||||||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
City or Town |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State |
|
Zip Code |
County |
|
||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Address Where You Live - If different from your mailing address |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||||||||||||||||||
|
(Include Street Number and Name, Rural Delivery, and/or Box) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Apt. # |
|
||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
City or Town |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State |
|
Zip Code |
County |
|
||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
Address Change for: |
|
oMailing Address |
oLegal Address |
|
|
|
|
|
|
|
|
|||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
Name Change: Print your former name exactly as it appears on your escort certificate |
|
|||||||||||||||||||||||||||||||||||||||||
|
Does any of the information |
|
|
|
|||||||||||||||||||||||||||||||||||||||||||||||
|
on your Escort Certificate |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||
|
have to be changed? |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||
|
|
oYes oNo |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
|
|
|
Other Change: What is the change and the reason for it ( wrong date of birth, etc.)? |
|
|
|
|
|
|
|
|
|||||||||||||||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
I state that the information I have given on this application is true to the best of my knowledge. I certify that I am the holder of a valid driver license that is not now suspended or revoked, and that I have not lost my privilege to drive in New York State.
SIGN HERE ➧___________________________________________________________
(Sign name in full - A married woman must use her own first name.)
DMV USE ONLY
Expiration |
Proof Submitted: |
Approved |
|
Date |
|
By |
|
|
oDriver License/ID |
|
|
Fee |
Office |
Date: |
|
|
|
|
|