Form MV-47 at a glance
What it is: This form is the DRIVER HISTORY DISCLOSURE.
Who signs: Under CERTIFICATION, you certify that the information you have given on this form is true.
A filled-in Form MV-47 example: a driver once licensed under another name
How to fill out Form MV-47, box by box
License ID, Name, Date of Birth
Enter the License ID, Name, Date of Birth and Last Four of Social Security Number.
Any other name
1) Have you ever applied for or been issued a driver license in New York State or elsewhere in any other name? Mark YES or NO. If Yes, please print the other name(s) in full by which you were previously known.
Places issued a driver license
Please list all places in which you have ever been issued a driver license. Include all U.S. states (including NY), territories and possessions, the District of Columbia, Canadian provinces or territories, and any jurisdictions that have reciprocity with New York State.
Alcohol/drugged driving convictions
3) Have you had any alcohol/drugged driving convictions in your lifetime? Mark YES or NO. If Yes, indicate how many in New York and how many in Other than New York.
Indicate the non-New York state(s) or other location(s) and the year in which those alcohol/drugged driving conviction(s) occurred, in the STATE (or other location) and YEAR lines.
Signature and date
Sign on the Signature line and enter the Date.
Making a false statement on this disclosure, 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 this disclosure, may subject you to criminal prosecution for a misdemeanor or felony under the Vehicle & Traffic Law and/or Penal Law.
Sources
[1] Form MV-47 (1/25), Driver History Disclosure, New York State DMV (the Official source link on this page).