- Form DS-874C - Supplement to: Medical Examination of Driver Report - New York
- Form DS-3 - Article 19-A Annual Affidavit of Compliance - New York
- Form DS-872 - Carrier's Annual Review of Employee's Driving Record - New York
- Form DS-885 - Bus Driver Add/Drop Notice - New York
- Form DS-19 - Motor Carrier Accident and Conviction Notification Program Application - New York
- Form IRP-21 - IRP TEAR Request Form - New York
Fillable Printable Form DS-8701 - Article 19-A School District/Other Contract Notice - New York
Fillable Printable Form DS-8701 - Article 19-A School District/Other Contract Notice - New York
Form DS-8701 - Article 19-A School District/Other Contract Notice - New York
ARTICLE 19-A SCHOOL DISTRICT/OTHER CONTRACT NOTICE
DS-870.1 (6/15)
CARRIER INFORMATION
www.dmv.ny.gov
SCHOOL DISTRICT/OTHER CONTRACT INFORMATION
For EACH contract served, provide the following information. If you need more space to report contract information, you may photocopy this
page and attach the copies to this form.
o Add o Drop o Modify ⎯ Check ALL appropriate boxes to identify the type of institution/client groups served:
oAcademic o Day Care o Mentally Disabled o Vocational oNursery/Pre-School
oCamp o Religious o Physically Disabled o Other (Specify) ________________________________
Federal I.D. Number of Contract Contract Name
County Telephone Number (Area Code)
( )
Mailing Address (Include No. and Street)
City
State Zip Code
Name of Article 19-A
Contact Person
Title of Contact Person
Contract Period
o Add o Drop ⎯ Check ALL appropriate boxes to identify the type of institution/client groups served:
oAcademic o Day Care o Mentally Disabled o Vocational oNursery/Pre-School
oCamp o Religious o Physically Disabled o Other (Specify) ________________________________
Federal I.D. Number of Contract Contract Name
County Telephone Number (Area Code)
( )
Mailing Address (Include No. and Street)
City
State Zip Code
Name of Article 19-A
Contact Person
Title of Contact Person
Contract Period
o Add o Drop ⎯ Check ALL appropriate boxes to identify the type of institution/client groups served:
oAcademic o Day Care o Mentally Disabled o Vocational oNursery/Pre-School
oCamp o Religious o Physically Disabled o Other (Specify) ________________________________
Federal I.D. Number of Contract
Contract Name
County Telephone Number (Area Code)
( )
Mailing Address (Include No. and Street)
City
State Zip Code
Name of Article 19-A
Contact Person
Title of Contact Person
Contract Period
Send original to New York State Department of Motor Vehicles, Bus Driver Unit; keep a copy in your files.
All questions pertaining to this form and/or the Article 19-A Program should be directed to: New York State Department of Motor Vehicles,
Bus Driver Unit, 6 Empire State Plaza, Room 220C, Albany, NY 12228, (518) 473-9455.
Street Address City State Zip Code
NOTE: This form shall be submitted by a carrier anytime
a contract is added, dropped, or modified.
Carrier/DBA Name
Legal Name (if different) 19-A Business ID NumberFederal ID Number
Signature of Carrier Representative ______________________________________________________________________
Print Name: ___________________________________________________________________ Date: __________________
ç
reset/clear
