Form MV-44EDL - Application for Enhanced Permit, Driver License or Non-Driver ID Card - New York
(mark all that apply):
MARK THE BOX OF THE TYPE OF DOCUMENT OR SERVICE YOU NEED
MV-44EDL (5/15)
o
oo o o o
Learner
Permit
o
Upgrade Current
Document to EDL
ID
card
Renewal Replacement
Change
NYS license in exchange for a license from another US
State, the District of Columbia or Canadian Province
This form is also available at www.dmv.ny.gov
PRINT CLEARLY IN BLUE OR BLACK INK.
Other
Restrictions
License
Class
Special
Conditions
Endorsements
F
O
R
O
F
F
I
C
E
U
S
E
ADDRESS WHERE YOU GET YOUR MAIL
- Include Street Number and Name, Rural Delivery and/or box number (If you have a PO box, also fill in “Address Where You Live” below)
ADDRESS WHERE YOU LIVE
REQUIRED IF DIFFERENT FROM ADDRESS FOR MAIL - DO NOT GIVE P.O. BOX. THIS ADDRESS WILL APPEAR ON YOUR DRIVER LICENSE.
APPLICATION FOR ENHANCED PERMIT, DRIVER LICENSE
OR NON-DRIVER ID CARD
PLEASE COMPLETE AND SIGN PAGE 2.
Month Day Year
* 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.
What is the change and the reason for it (new
license class, wrong date of birth, etc.)?
OTHER CHANGE:
Male Female
oo
FULL LAST NAME
FULL FIRST NAME
FULL MIDDLE NAME
SUFFIX
DATE OF BIRTH SEX HEIGHT
EYE COLOR
SOCIAL SECURITY NUMBER
* (SSN)
DAY PHONE NO.
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
District of Columbia or a Canadian Province?
o Yes o No
If “Yes”, where was it issued? ____________________________
Date of Expiration: Type of License: Out-of-State License ID No.:
Area Code
( )
Apt. No. City or Town State Zip Code
Apt. No. City or Town State Zip Code
County
County
Feet Inches
}
IDENTIFICATION INFORMATION
NYS DRIVER LICENSE, LEARNER PERMIT, or
NON-DRIVER ID CARD NUMBER
If “Yes”, enter the identification number as it appears
on the license, learner permit, or non-driver ID card.
¦
Driver license? . . . . . o Yes o No
Learner permit? . . . .
o Yes o No
Non-driver ID Card?
o Yes o No
Do you now have, or did you ever have a New York:
If “Yes”, print your former name
exactly as it appears on your present license or non-driver ID card.
Has your name changed?
o Yes o No
Email Address: (optional)
Has your mailing address changed? o Yes o No
Has the address where you live changed?
o Yes o No
(Please answer “yes” or “no”.)
VOTER REGISTRATION QUESTIONS
NEW YORK STATE ORGAN AND TISSUE DONATION
Check 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 check 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 be applying 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
Check this box if you would like to have “Veteran” printed on the front of your photo document.
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: 18 years or older; consenting to donate all of your organs and tissues for transplantation, research or both; authorizing DMV
to transfer your name and identifying information to DOH for enrollment in the Registry; and authorizing 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
provide you an opportunity to limit your donation.
o
o
o
(You must fill out the following section)
You must present proof that indicates an honorable discharge from military service. For additional information, please see form MV-44.1.
You must answer the following question
: Would you like to be added to the Donate Life Registry?
Yes (sign and date consent below)
Skip This Question
PAGE 1 OF 3
Image #
OFFICE USE ONLY
A B C NCDL-C D DJ
E ID M MJ
AM DP LR TR LS BC
ML NF TD UC UP UR X8 XT
o Birth Certificate
o U.S. Passport
o Foreign Passport
o Driver License/ID
o Learner Permit
o MV-45
o Out of-State-License
o DHS Document(s)
o Medical Certificate (CDL Only)
o Image Retrieval
o Social Security Card
o Credit Card
o ATM Card
Other:
NI NA EI EA
Proof Submitted:
Approved By Date
Office
o TEENS
o License/Permit
Surrendered for
Non-Driver ID Card
CDL Certifications
Page 1/3
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