- Form MV-285R - Student MV-285 Roster - New York
- Form MV-278.8SSC - Pre-Licensing Course Completion Certificate Order Form - New York
- Form MV-526 - Driving School Instructor Termination Notice - New York
- Form MV-523 - Application for Driving School Instructor Certificate - New York
- Form MV-521 - Driving School License Application - New York
- Form DTP-421 - Intent to Conduct DMV's 30-Hour Basic Instructor's Course Notice - New York
Fillable Printable Form MV-285R - Student MV-285 Roster - New York
Fillable Printable Form MV-285R - Student MV-285 Roster - New York
Form MV-285R - Student MV-285 Roster - New York
STUDENT MV-285 ROSTER
(Please Print or Type)
Certificate No. Date of Birth
To knowingly make a false statement or conceal a material fact in this Student MV-285 Roster is a criminal offense.
False statements are punishable under Section 210.45 of the Penal Code.
_______________________________________________ ______________________________ ____________________
Mail completed roster to: NYS Department of Motor Vehicles
Utica Processing Center
MV-285/MV-278
207 Genesee Street
Utica, NY 13501
Telephone (315) 793-2615
Last Name, First Name, Middle Initial and
Address of Student
Class
Hours
Total
Hours
Duplicate
Certificate No.
and Date Issued
Student’s Client
ID Number
(if available)
Laboratory Hours
Behind the
Wheel
Observation Simulation Range
Numerical Grade
Received
Behind the
Wheel
Classroom
Name of School
Address (Number and Street) City State Zip Code
Telephone Number (include area code)
( )
Signature of Superintendent or Principal
ç
Contact Person Dates course was offered:
From: / / To: / /
Date certificates were issued:
/ /
MV-285R (10/15)
Signature of Approved MV-283 Lecture Teacher Instructor Certificate Number
Date
ç
/ /
(If multiple Lecture Teachers are employed, only Lead Teacher Signs)
