Fillable Printable Form MV-44NYR - Certification of Residence - New York

Form MV-44NYR - Certification of Residence - New York

New York State Department of Motor Vehicles

CERTIFICATION OF RESIDENCE

MV-44NYR (8/08)

FOR OFFICE USE

This Certification of Residence can be used to provide proof of principal residence address and should be completed by

the individual making the certification and the applicant for which the certification applies. This form must accompany

one additional proof of principal residence in the applicant’s name. A list of acceptable residence proofs can be found on

form ID-44EDL.

Relationship of individual making certification can include:

 Co-resident

 Employer

 Landlord

 Neighbor

 Parent or Legal Guardian

 School Official

 Spouse

I, __________________________________________________________ , as the ____________________________________

certify

________________________________________________________________________________, currently resides at

______________________________________________________________________________________________________

and that this name is the name by which (s)he is commonly known and that (s)he resides at the address above. I state

that the information I have given in this certification is true to the best of my knowledge. I understand that any false

statement I have made on this certification is a misdemeanor under Section 392 of the Vehicle and Traffic Law.

Individual Making Certification (Print Name Here)

: ____________________________________________________

Signature of Individual Making Certification

± ________________________________________________________

Applicant (Print Name Here)

: ______________________________________________________________________

Signature of Applicant

±__________________________________________________________________________

MAKING ANY FALSE STATEMENT ON THIS CERTIFICATION OF RESIDENCE IS PUNISHABLE BY LAW.

CERTIFICATION

(Name) (Relationship of Individual Making Certification)

(Address)

(Name of Applicant)

Signature of DMV Employee Accepting Proof ± ______________________________________________________

Signature of DMV Supervisor Accepting Proof

: ± ________________________________________ Date: ____________

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