Form MV-44CR - Restricted Use or Conditional Driver License Application - New York
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MV-44CR (12/14)
Case
No.
Order
No.
LAM LRN LDP LNO
D DJ E M MJ NCDL-C
AM CL DP IL
LR NF RL
New York State Department of Motor Vehicles
RESTRICTED USE OR CONDITIONAL
DRIVER LICENSE APPLICATION
Stop/Response Validation Number
License
Class
Special
Conditions
Restrictions
Exp. Date
Fee
Proof Submitted
Approved By Date
Office
oBirth Certificate o Driver License/ID
oCredit Card o Passport
oINS Papers o Image Retrieval
oSocial Security Card
Other:
PLEASE COMPLETE AND SIGN PAGE 2.
Eye Test o Pass o Corrective Lens
IMPORTANT: You cannot use a restricted use license to drive a vehicle for hire, unless your license is suspended or revoked because of an uninsured accident,
an insurance lapse, uninsured operation of a motor vehicle, or for delinquent child support payments. You cannot use a restricted use license to operate a
commercial vehicle. You cannot use a conditional license to drive a commercial vehicle or a vehicle for hire.
F
O
R
O
F
F
I
C
E
U
S
E
PLEASE PRINT CLEARLY IN BLUE OR BLACK INK.
o Apply for a restricted
use license
o Replace a restricted use or
conditional license
o Renew a restricted use or
conditional license
o Apply for a
conditional license
o Change information on a
restricted use or conditional license
MARK THE BOX OF THE TYPE OF SERVICE YOU NEED (YOU CAN MARK MORE THAN ONE)
MV-44CR (12/14)
* You must provide your SSN. Authority to collect your SSN is granted by Sections
490.3 and 502 of the Vehicle and 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.
SOCIAL SECURITY NUMBER* (SSN)
NYS DRIVER LICENSE OR NON-DRIVER ID CARD NUMBER
FULL LAST NAME
FULL FIRST NAME
FULL MIDDLE NAME
Month Day Year
Male Female
oo
SUFFIX
DATE OF BIRTH SEX HEIGHT
EYE COLOR
DAY TELEPHONE (Optional)
Area Code
( )
Feet Inches
ADDRESS WHERE YOU GET YOUR MAIL
Apt. No. City or Town State Zip Code
- Include Street Number and Name, Rural Delivery and/or box number (If you have a PO Box, also fill in “Address Where You Reside” below)
ADDRESS WHERE YOU RESIDE
Apt. No. City or Town State Zip Code
County
County
IF DIFFERENT FROM YOUR MAILING ADDRESS - DO NOT GIVE A P.O. BOX.
What is the change and the reason for the change
(new license class, wrong date of birth, etc.)?
OTHER CHANGE:
If “Yes”, print your former name exactly as your former name
appears on your present driver license or non-driver ID card.
Has your name changed?
o Yes o No
Has the address where
you get your mail changed?
o Yes o No
Has the address where you live changed? o Yes o No
(Please mark “yes” or “no”.)
VOTER REGISTRATION QUESTIONS
NEW YORK STATE ORGAN AND TISSUE DONATION
Mark this box to make a $1
voluntary contribution to the Life...Pass
It On Trust Fund. The $1 donation will
be added to your total transaction fee. A
contribution to the Fund is used for
organ donation and transplant research
and educational projects promoting
organ and tissue donation.
o
♥Donor Consent Signature: ç ____________________________________________________ Date:__________________
SM
If you are not registered to vote where you live now, would you like to apply to register, or if you are changing your address, would you like the Board of Elections to be notified?
NOTE: If you do not mark either box, you will be considered to have decided not to register to vote.
YES - Complete Voter Registration Application Section
(Not necessary if you will apply in person at a DMV office).
o
o
NO - I Decline to Register/Already Registered/I do not want to notify
the Board of Elections of my change of address.
VETERAN STATUS
Mark this box to have “Veteran” printed on the front of your photo document.
To enroll in the NYS Department of Health’s Donate Life Registry, mark the “yes” box then sign and date below. You are certifying that
you: are age 18 or older; consent to donate all of your organs and tissues for transplantation, research or both; authorize DMV to
transfer your name and identifying information to DOH for enrollment in the Registry; and authorize DOH to allow access to this
information to federally regulated organ donation organizations and NYS-licensed tissue and eye banks and hospitals, upon your death.
“ORGAN DONOR” will be printed on the front of your DMV photo document. You will receive a confirmation from DOH, which will also
give you an opportunity to limit your donation.
You must answer the following question
: Would you like to be added to the Donate Life Registry? Yes Skip This Question
o o
o
(You must fill out the following section)
You must present proof of honorable discharge from military service. For more information, refer to form MV-44.1.
IDENTIFICATION INFORMATION
NEW YORK STATE VOTER REGISTRATION APPLICATION
Only
fill this out if you want to register to vote or change your address or other information with the Board of Elections.
If you register to vote, your completed voter registration application will be sent directly to the Board of Elections. If you decline to register, your decision will
remain confidential. You will be notified by your County Board of Elections when your voter registration application has been processed.
Have you voted before?
o Yes o No
What Year?
Your name was
Your address was
Voting information that
has changed:
skip if this has not changed or
you have not voted before.
Your state or NYS
County was:
Are you a citizen of the U.S.?
o Yes o No
If you answer NO, you cannot register to vote
Will you be 18 years of age or older on or before election day?
o Yes o No
If you answer NO, you cannot register to vote unless you will be 18 by the end of the year.
X
Sign
AFFIDAVIT: I swear or affirm that
l I am a citizen of the United States.
l I will have lived in the county, city, or village for at least 30 days before the election.
l I meet all requirements to register to vote in New York State.
l This is my signature or mark on the line below.
l The above information is true, I understand that if it is not true, I can be convicted and fined up to $5,000 and/or
jailed for up to four years.
Political Party
Telephone Number (optional)
o Democratic party
o Republican party
o Conservative party
o Green party
o Working Families party
o Independence party
o Women’s Equality party
o StopCommonCore party
o Other (write in) ____________
o I do not wish to enroll in a party
You must make 1 selection
To vote in a primary
election, you must be
enrolled in one of these
listed parties - except the
Independence Party, which
permits non-enrolled voters
to participate in certain
primary elections.
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