Fillable Printable Form DS-3 - Article 19-A Annual Affidavit of Compliance - New York

Form DS-3 - Article 19-A Annual Affidavit of Compliance - New York

____________________________________________

www.dmv.ny.gov

In accordance with Article 19-A, Section 509-j of the New York State Vehicle and Traffic Law and Part 6 of the

Commissioner’s Regulations, a motor carrier is required to file an Annual Affidavit of Compliance no later than July1

each year in order to operate within this State.

Please refer to the “INSTRUCTIONS FOR COMPLETING THE ARTICLE 19-A ANNUAL AFFIDAVIT OF

COMPLIANCE” (form DS-3.1). After you are satisfied that all requirements have been met, complete this affidavit

and sign it. Send the affidavit with all appropriate supporting documentation to:

New York State Department of Motor Vehicles

Bus Driver Unit, Room 136B

6 Empire State Plaza

Albany, NY 12228

I hereby certify that all officers, agents, representatives and employees responsible for the management, maintenance,

operation or driving of motor vehicles, or the hiring, supervising, training, assigning, or dispatching of drivers for this

motor carrier have been instructed in and are in compliance with all provisions of Article 19-A including, but not

limited to, the required annual and biennial procedures as outlined in Article 19-A of the New York State Vehicle and

Traffic Law and Part 6 of the Commissioner's Regulations.

Failure to file an acceptable Annual Affidavit of Compliance is a violation of Section 6.22(c) of the Commissioner's

Regulations. Affidavits must be received in the Bus Driver Unit by July 1st. They also must be found to be

acceptable. Failure to comply with these requirements will result in the suspension of all your vehicle registrations

and/or the privilege of operation in New York State.

DS-3 (2/15)

(Authorized Signature and Title) (Date)

__________________________________

Carrier Name

Date

Federal ID Number

Address (Include Number and Street)

City

State Zip Code 19-A Business ID Number

BUS DRIVER UNIT

ARTICLE 19-A MOTOR CARRIER

ANNUAL AFFIDAVIT OF COMPLIANCE

6 EMPIRE STATE PLAZA, ROOM 136B

ALBANY, NY 12228

(518) 473-9455

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