- Form MV-44NYR - Certification of Residence - New York
- Form DS-6 - Physician's Request for Driver Review - New York
- Form UT-11C - County Use Tax Exemption Certificate - New York
- Form DS-115 - Request for Driving Privileges - New York
- Form MV-80L - Eye Test Report for Medical Review Unit - New York
- Form MV-80 - Physician's Statement - New York
Fillable Printable Form MV-44NYR - Certification of Residence - New York
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.
t
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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