Form Ndr 1 – Fill Out and Use This PDF

NewYorkStateDepartmentofMotorVehicles

INDIVIDUAL’S REQUEST FOR

NATIONALDRIVER REGISTER FILE SEARCH

The National Driver Register (NDR) is a database of information about drivers whose driver licenses havebeen suspended, revoked, denied or withdrawn, or who have been convicted of certain serious traffic violations.Any person may ask if there is information about him/her on the NDRfiles,whetherthisinformationhasbeendisclosedtoanyone,andtowhomitwasdisclosed.YouwillnotbelistedintheNDRifyouhave nothadadriverlicensecancelled,denied,revokedorsuspended,orhavenotbeenconvictedofaserioustrafficviolation.

NDR search results will be mailed directly to you at the address provided on this form. The NDR will not process your request: if the information provided on this form is incomplete or cannot be read; or if the form is not signed in the presence of a Motor Vehicles representativeorisnotnotarized.

The NDR will respond to every processed request, including those where no record is found on file. If a record is found, the full record will be copied and sent directly to you, including any older records that may have contained a reason for the license cancellation, denial, revocation or suspension.Also, if the NDR information has been released to anyone, the report will identify who received it. The name and address of the licensing authority in each state that reported the information will be provided in the report in case you want to ask for more detailed information about the action reported, or if you need to correct an error. Obtaining specific information about your record, orcorrecting errors, can only be done by contacting the state(s) that provided the information to the NDR.You can contact the NDR office Monday through Friday bycallingtheirtollfreenumber1-888-851-0436.

INSTRUCTIONS:

◆Typeorclearlyprintallinformationrequested.

◆ThepersonwhoserecordisbeingcheckedmustauthorizetheNDRsearchbysigningthisforminthepresenceofaMotorVehicles representative,andmustpresentproofofidentity(seeformID-44foracceptableproofsofidentity).Youmaypre-signtheform, providingyoursignatureisnotarized.

◆YoumaysendthisformdirectlytotheNDRatthefollowingaddress:

NationalDriverRegister 1200NewJerseyAve.S.E. WashingtonDC 20590

OR

youmayaskaMotorVehiclesofficetosendyourrequesttotheNDRforyou.A$10feeischargedtodothispayablebycash,orbycheck ormoneyordermadepayabletotheCommissioner of Motor Vehicles.

Last Name		First							M.I.
Previous Last Name or Maiden Name		Date of Birth (Mo./Day/Year)			Sex			Height	Eye Color
		/	/		M	F
Address Where You Get Your Mail (Include Street Number and Name, Rural Delivery and/or Box Number)										Apt. No.
City or Town				State				Zip Code
Driver License Number	State Where License was Issued		Social Security Number (Optional)

SIGN HERE ç__________________________________________________________________ Date ____________________________

(Sign Name in Full)

FOR OFFICE USE ONLY- NOT TO BE COMPLETED BYCUSTOMER			NOTARIZATION —Required only if this form is not
Proof Submitted Birth Certificate	Driver License/ID Credit Card Passport Learner Permit INS Papers		signed in the presence of a Motor Vehicles representative.
Other:			Sworn to and ascribed before	Notary Public
			me this______________ day	Seal or Stamp
Approved By		Office	of________________ in the
(Print Name)
			year of __________ in the city/
			county of__________________
SIGNATURE ç		Date
			State of___________________