Form Mv-44 - Application For Permit, Driver License Or Non-Driver Id Card - New York Dmv

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MV-44 (8/17)

APPLICATION FOR PERMIT, DRIVER LICENSE OR NON-DRIVER ID CARD

PLEASE PRINT CLEARLY IN BLUE OR BLACK INK.

OFFICE USE ONLY

This form is also available on DMV’s web site at: dmv.ny.gov

Image #

I AM APPLYING FOR A

(check any that apply):

NYS license in exchange for a license from another

ID card

Change

Learner Permit

Renewal

US State, the District of Columbia or Canadian Province

IDENTIFICATION INFORMATION

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

ID NUMBER ON NYS DRIVER LICENSE, LEARNER

}

PERMIT, or NON-DRIVER ID CARD

Driver license? . . . . .

Yes

If “Yes”, enter the 9-digit ID number as it appears on the

Learner permit? . . . .

Yes

front of the license, learner permit, or non-driver ID card.

Non-driver ID Card?

Yes

FULL LAST NAME

Do you have or did you ever have a driver license that is valid or that

expired within the last two years, issued by another US State, the

FULL FIRST NAME

District of Columbia or a Canadian Province?

Yes

If “Yes”, where was it issued? ____________________________

FULL MIDDLE NAME

Date of Expiration: Type of License:

Out-of-State License ID No.:

SUFFIX

DATE OF BIRTH

SEX

HEIGHT

EYE COLOR

TELEPHONE NUMBER

Month

Day

Year

Male

Female

Feet

Inches

Area Code

(

)

If “Yes”, print your former

MOBILE PHONE NUMBER

name exactly as it appears on your present license or non-driver ID card.

Area Code

(

)

* You must provide your SSN. Authority to collect your SSN is granted by Sections 490.3 and 502 of the Vehicle and

SOCIAL SECURITY NUMBER

(SSN)

Traffic Law. The information will be used only for exchange with other jurisdictions, to assist in verification of

identity, and to invoke driver license sanctions pursuant to V&T Law Section 510(4-e) and 510(4-f). Your number will not be given to

the public, or appear on any form or information request.

ADDRESS WHERE YOU GET YOUR MAIL

(This address will appear on your document.) -- Include Street

Number and Name, Rural Delivery and/or box number (If PO Box, also fill in “Address Where You Live” below)

Apt. No.

City or Town

State

Zip Code

County

ADDRESS WHERE YOU LIVE

IF DIFFERENT FROM MAILING ADDRESS - DO NOT GIVE P.O. BOX.

Apt. No.

City or Town

State

Zip Code

County

HAS THE ADDRESS WHERE YOU LIVE CHANGED?

Yes

HAS YOUR MAILING ADDRESS CHANGED?

Yes

If you answered yes to either of the questions above, then addresses on all vehicle registrations tied to your ID number will also be updated with this address, unless you

check this box

. If you are registered to vote, your voter registration record will be updated when you complete and submit this form. If you do NOT want your new address

on your voter registration record, check this box

. If you do not check the box, your new address will be sent to the Board of Elections of your county of residence.

What is the change and the reason for it

(new license class, wrong date of birth, etc.)?

Check this box if you would like to have “Veteran” printed on the front of your photo document.

VETERAN STATUS

You must present proof that indicates an honorable discharge from military service. For additional information, please see form MV-44.1.

NEW YORK STATE ORGAN AND TISSUE DONATION

(You must fill out the following section)

Check this box to make a

To enroll in the NYS Department of Health’s Donate Life Registry, check the “yes” box and then sign and date below. You are certifying that you are: 16

$1 voluntary donation to the

years of age or older; consenting to donate your organs and tissues for transplantation, research or both; authorizing DMV to transfer your name and

Life...Pass It On Trust Fund

identifying information to DOH for enrollment in the Registry; and authorizing DOH to allow access to this information to federally regulated organ

for organ and tissue donation

donation organizations and NYS-licensed tissue and eye banks and hospitals, upon your death. “ORGAN DONOR” will be printed on the front of your

research and outreach. Your

DMV photo document. You will receive a confirmation from DOH, which will also provide you an opportunity to limit your donation. If you are 16 or 17

total transaction fee will

years of age, parents/legal guardians may rescind or amend your decision upon your death.

include the $1.

Yes (sign and date consent below)