Fillable Printable Form DTP-421 - Intent to Conduct DMV's 30-Hour Basic Instructor's Course Notice - New York

Form DTP-421 - Intent to Conduct DMV's 30-Hour Basic Instructor's Course Notice - New York

NOTICE OF INTENT TO CONDUCT

DMV’s 30-HOUR BASIC INSTRUCTOR’s COURSE

RIVER TRAINING PROGRAMS

DTP-421 (9/15)

Date

Session Hour(s) Location Instructor Client ID

COURSE SCHEDULE

Print Name of Owner or Corporate Officer and Title

Date

Signature of Owner or Corporate Officer and Title

Driving School Offering Course:__________________________________________________________________________

Address: ____________________________________________________________________________________________

Number of Students Enrolled: ____________ AMENDED ON: ____________________

I certify that all information and other matters contained herein are true in substance and in fact. Part 76.23(a)(5) of Commissioner’s

Regulations authorizes the Department of Motor Vehicles to suspend or revoke a driving school license for “the failure of the

licensee or any partner, officer, agent or employee of the licensee to conduct the prescribed tests for instructor applicants in the

manner authorized by this department and/or the failure of the licensee or any partner, officer, agent or employee of the licensee to

conduct the 30-hour course to instructor applicants according to the curriculum supplied by this department and/or for the number

of hours required by this department and this Part”.

This form must be submitted to DMV 30 days prior to the start date of the course. Return to:

New York State Department of Motor Vehicles

Bureau of Driver Training Programs

6 Empire State Plaza, Room 221

Albany NY 12228

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