Fillable Printable Form DS-115 - Request for Driving Privileges - New York

Form DS-115 - Request for Driving Privileges - New York

Signature (required)

_______________________________________________________________________________

Date _________________________

To request clearance for New York State Driving Privileges, please fill in the following information and

include a non-refundable $25.00 check/money order made payable to the Commissioner of Motor Vehicles.

Mail form and check/money order to:

NYS Department of Motor Vehicles

6 Empire State Plaza

Albany, NY 12228

Attention: Driver Improvement Unit, Room 336

Full Last Name Full First Name MI

Daytime Phone Number (Area Code) - (Optional)

( ) -

DS-115 (3/15)

Sex

o M o F

NYS Driver License, Learner Permit or Non-Driver ID Card Number (if available)

Number and Street

City or Town State Zip Code

Apt. Number

CURRENT OUT-OF-STATE RESIDENCE ADDRESS

(Sign name in full)

Date of Birth (mm/dd/yy)

/ /

Number and Street

City or Town State Zip Code

Apt. Number

MAILING ADDRESS IF DIFFERENT THAN RESIDENCE

REQUEST FOR NYS DRIVING PRIVILEGES

Clear