- Form UT-11C - County Use Tax Exemption Certificate - New York
- Form MV-80L - Eye Test Report for Medical Review Unit - New York
- Form DS-6 - Physician's Request for Driver Review - New York
- Form MV-44NYR - Certification of Residence - New York
- Form MV-80 - Physician's Statement - New York
- Form DS-115 - Request for Driving Privileges - New York
Fillable Printable Form DS-115 - Request for Driving Privileges - New York
Fillable Printable Form DS-115 - Request for Driving Privileges - New York
Form DS-115 - Request for Driving Privileges - New York
Signature (required)
รง
_______________________________________________________________________________
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
