LIST OF DRIVING SCHOOL VEHICLES
You must complete and send this list to the address shown on the right:
u
- with your application for an original license; or,
Send all lists to:
- with your renewal application; or,
DEPARTMENT OF MOTOR VEHICLES
- after your school is licensed, EACH time you add or replace a vehicle.
BUREAU OF DRIVER TRAINING PROGRAMS
List all vehicles used for instruction or road tests. (Use additional forms if necessary.) This includes:
u
6 EMPIRE STATE PLAZA, ROOM 412
- a vehicle owned by the school
ALBANY NY 12228
- a vehicle owned by an instructor
- a leased vehicle
- any other vehicle used for instruction or road tests. For each vehicle, a written authorization signed by the registrant or
owner confirming that the school has permission to use the vehicle for these purposes must be attached.
VEHICLE
LICENSE
YEAR OF
MAKE AND MODEL
REGISTRANT
VEHICLE
OF VEHICLE
IDENTIFICATION NUMBER
PLATE NUMBER
(Name on vehicle registration)
CERTIFICATION:
My signature below affirms that each vehicle listed above: is, and will remain, properly insured for driving instruction; is equipped in accordance with Commissioner’s Regulations Part 76,
Section 76.11; and any advertising placed on these vehicles complies with Commissioner’s Regulations Part 76, Section 76.21.
IMPORTANT: To knowingly make a false statement or conceal a material fact on this form is a criminal offense, and may result in the revocation of your driving school license.
Name of Driving School
Date
(Print Full Name & Title of Owner or Authorized Representative )
Full Signature
First Name
Middle
Last
Title
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MV-527 (9/15)
dmv.ny.gov
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