Form MV-65 - Vehicle Escort Driver Application - New York

New York State Department of Motor Vehicles
VEHICLE ESCORT DRIVER APPLICATION
www.dmv.ny.gov
M F
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Note: To become a certified vehicle escort driver, you MUST:
l Have a valid driver license l Pay a $40 fee l Present proof of ID
l Be at least 21 years old l Pass a written exam (as listed on ID-44)
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.
Month Day Year
o Original Certification o Renewal o Replace Certificate o Amend Certification
Name of Applicant (Last, First, Middle)
Phone Number (Include area code)
Action Wanted:
Date of Birth
Client ID number as it appears on your
NYS Vehicle Escort card (if available)
State/Province of
driver license Driver License Number
Address Where You Get Your Mail (Include Street Number and Name, Rural Delivery, and/or Box) Apt. #
City or Town State Zip Code County
FEET INCHES
Height
Eye Color
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
Name Change:
Print your former name exactly as it appears on your escort certificate
Zip Code County
Other Change: What is the change and the reason for it ( wrong date of birth, etc.)?
MV-65 (12/14)
Sex
DMV USE ONLY
Approved
By
Expiration
Date
Proof Submitted:
o Driver License/ID
Fee
Office
Date:
Address Change for: o Mailing Address o Legal Address
Does any of the information
on your Escort Certificate
have to be changed?
o Yes o No
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.
SIGN HERE
ç ___________________________________________________________
(Sign name in full - A married woman must use her own first name.)
PLEASE PRINT WITH BLUE OR BLACK INK IN THE BOXES
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Form MV-65 - Vehicle Escort Driver Application - New York PDF

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