Form Mv-65 - Vehicle Escort Driver Application
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1MV-65 (5/16)
VEHICLE ESCORT DRIVER APPLICATION
dmv.ny.gov
PLEASE PRINT WITH BLUE OR BLACK INK IN THE BOXES
Note: To become a certified vehicle escort driver, you MUST:
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Have a valid driver license
Pay a $40 fee
Present proof of ID
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Be at least 21 years old
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Pass a written exam
(as listed on ID-44)
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o
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Action Wanted:
Original Certification
Renewal
Replace Certificate
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, Room 136B, Albany,
New York 12228. A $5.00 check (payable to the Commissioner of Motor Vehicles) is required for 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)
Sex
Height
Phone Number (Include area code)
Date of Birth
Eye Color
Month
Day
Year
FEET
INCHES
M
F
o o
State/Province of
Client ID number as it appears on your
driver license
Driver License Number
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
o
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Address Change for:
Mailing Address
Legal 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?
o
o
Yes
No
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.
ç ___________________________________________________________
SIGN HERE
(Sign name in full - A married woman must use her own first name.)
DMV USE ONLY
Expiration
Proof Submitted:
Approved
Date
By
o
Office
Date:
Fee
Driver License/ID
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