Fillable Printable Form MV-521 - Driving School License Application - New York

Form MV-521 - Driving School License Application - New York

DRIVING SCHOOL LICENSE APPLICATION

MV-521 (9/15)

PAGE 1 OF 7

oIndividual with assumed name [sole proprietor or “doing business as” (DBA) name]

Ø Enclose a copy of the certified business certificate certified by the County Clerk’s office.

oPartnership with assumed name [“doing business as” (DBA) name]

Ø Enclose a copy of the Certified Business Certificate for Partners certified by the County Clerk’s office. The partnership

papers must contain all partners’ names and the DBA name.

oCorporation (Inc., Corp., Ltd.)

Ø Enclose a copy of the filing receipt issued from the NYS Department of State: (518) 473-2492 or www.dos.ny.gov

Ø If corporation is a DBA, you must also complete “Corporation with assumed name.”

oCorporation with assumed name [“doing business as” (DBA) name]

Ø Print corporation name below and enclose a copy of the Certificate of Assumed Name issued by the NYS Department

of State: (518) 473-2492 or www.dos.ny.gov

Corporation Name____________________________________________________________________________

oLimited Liability Company (LLC)

Ø Enclose a copy of the filing receipt issued by the NYS Department of State: (518) 473-2492 or www.dos.ny.gov

School Information:PART 1

Check type of ownership (one ownership type per application) and include paperwork described below:PART 2

If you need assistance, call the Bureau of Driver Training Programs at 518-473-7174.

Forms are available at www.dmv.ny.gov/driveschool.htm

DMV USE ONLY

APPLICATION

No.

Date Received Fee Amount

No.

Expiration Date Fee Amount

LICENSE

* If your application for an original license or change of ownership is approved, you must pay a license fee of not more than $100 for a two-

year license. If your application for a branch license is approved, the fee is $1.50 per year. The fees are payable to “Commissioner of

Motor Vehicles”, in the form of a check (“starter checks” cannot be accepted) or money order.

lREADVEHICLE ANDTRAFFIC LAWSECTION 394 AND DMV COMMISSIONER’S REGULATIONS PART76 BEFORE FILLING IN THIS FORM.

lPrint clearly or type.

oOriginal license application*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 50.00(non-refundable)

oBranch license application*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No fee

oChange of ownership*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 50.00 (non-refundable)

oAdd Partner(s) or Person(s) to business. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No fee

oChange of address. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No fee

oChange of business name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No fee

oIncorporating. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No fee

Application Fee Schedule

All fees are payable to

“The Commissioner of Motor Vehicles”

Address of Main Office

Address of Branch Office

Name of Driving School

Last Name

First

Title

Contact Information - What is the name, phone number and email address of the individual we should send information to? If the

school has a website, please provide the website address. You must submit a Personal History (form MV-521.1) for this individual.

Please check the appropriate box below. See also “Additional Information” starting on page 6.

E-mail Address

Driving School Website Address

Business Phone No. (Area Code)

( )

Business Phone No. (Area Code)

( )

Fax Number (Area Code)

( )

Fax Number (Area Code)

( )

Home Phone No. (Area Code)

( )

Fax Number (Area Code)

( )

www.dmv.ny.gov

Own (complete Section A)

Lease (complete Sections A and B)

Sublease (complete Sections A, B and C)

PLACE OF BUSINESS: DO YOU

{

Business Name

Business Street Address (physical location)

A.INDIVIDUAL OWNERSHIP: If owner is an out-of-state resident, attach government

issued ID or recent official copy of driver record.

B.PARTNERSHIP: Complete one section for each partner; if more than three, attach additional pages. If partner is an out-of-state resident, attach

government issued ID or recent official copy of driver record.

Business Phone No. (Area Code)

( )

Residence Phone No. (Area Code)

( )

City

Last Name

Residence Address (Include Number and Street)

Please Sign Name In Full

Driver Identification NumberSocial Security Number

FirstMIDate of Birth (Month/Day/Year)

Residence Phone No. (Area Code)

( )

Last Name1.

Residence Address (Include Number and Street)

Please Sign Name In Full

Driver Identification NumberSocial Security Number

FirstMIDate of Birth (Month/Day/Year)

StateZIP

CityStateZIP

County

MV-521 (9/15)

PAGE 2 OF 7

FEIN (Federal Employer Identification Number)

Residence Phone No. (Area Code)

( )

Last Name2.

Residence Address (Include Number and Street)

Please Sign Name In Full

Driver Identification NumberSocial Security Number

FirstMIDate of Birth (Month/Day/Year)

Residence Phone No. (Area Code)

( )

Last Name3.

Residence Address (Include Number and Street)

Please Sign Name In Full

Driver Identification NumberSocial Security Number

FirstMIDate of Birth (Month/Day/Year)

PART 3

Ownership information (complete the section that applies):PART 4

Business E-mail Address

NAME OF DRIVING SCHOOL: ______________________________________________________________________________

Phone No. (Area Code)

( )

Name of Property Owner/Landlord

Owner Mailing Address (Include Number and Street)

City

Number of Years or Months Owned?

PLEASE NOTE: Whether you own or are leasing your business property, it is your responsibility to be in compliance with all state and local laws and regulations,

while being considered for a license and while conducting your business. You must provide a copy of the Certificate of Occupancy for all business locations. If

you do not provide this information with your application, the application will be denied

Is this property zoned for the business type(s) you are applying for? oYES oNO

StateZIP

C. If you are subleasing, complete this section and attach written approval from the landlord.

Phone No. (Area Code)

( )

A. All applicants must complete this section.

Print name and location of business, and business e-mail address, below:

Print the Name the Sublease is in (Sublessee Name)

Business Address

CityStateZIP

B. If you are leasing, complete this section.

Phone No. (Area Code)

( )

Print the Name the Lease is in (Lessee Name)

Business Address

Expiration Date

/ /

CityStateZIP

Expiration Date

/ /

www.dmv.ny.gov

MV-521 (9/15)

PAGE 3 OF 7

Power of Attorney - Give the following information about all persons who have power of attorney for your driving school. Please

include a copy of the Power of Attorney form with your application. If additional space is needed, attach additional page(s).

F.Questions

If you answer “Yes” to any question(s), please provide explanation and detail on page 4 or attach additional pages.

1. Have any of the owners, partners, corporate officers, managing members, managers or major stockholders ever

operated a driving school?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Have any of the owners, partners, corporate officers, managing members, managers or major stockholders ever been

convicted of a felony or crime involving violence, dishonesty, deceit, indecency, degeneracy or moral turpitude?....

3. Will you be offering the Prelicensing Course? If “Yes,” complete an Authorized Signature List (form MV-278.6)

and Request for Classroom Premises Check for Prelicensing Course (form MV-279) .. . . . . . . . . . . . . . . . . . . . .

4. Will your school offer Private Service Bureau services? If “YES”, attach a draft copy of your PSB receipt

showing all services and prices.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. Does or will your school offer a Point Insurance Reduction Program (PIRP)?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . oo

If “yes”, list the sponsor’s name and attach a list of all classroom locations used for PIRP classes:

6. What type(s) of vehicle(s) will you use for instruction?

oAuto oBus oMotorcycle oTractor-Trailer oTruck

D. Qualified Instructor – To be licensed, a driving school must employ at least one instructor who has a currently valid Driving

School Instructor Certificate (form MV-524) and at least 1,000 hours of behind-the-wheel instruction. In the space below,

provide the information pertaining to this instructor; also attach proof of the 1,000 hours of instruction.

Instructor’s Certificate Number

Total No. of Hours Teaching

In-Car Instruction

NAME OF DRIVING SCHOOL: ______________________________________________________________________________

C. CORPORATION or LIMITED LIABILITY COMPANY: For Inc., Corp., LLC, or Ltd., list corporate officers (President, Secretary and Treasurer are

required). List stockholders and percentage of stock. For LLC, list all managing members. Attach additional pages if needed. Attach a copy of each listed

person’s driver license. (If any listed person is an out-of-state resident, attach copy of government issued ID or recent official copy of driver record.

CityStateZIP

Last Name1.FirstMIDate of Birth (Month/Day/Year)

TitlePercentage of Stock

Residence Phone No. (Area Code)

( )

Residence Address (Include Number and Street)

Please Sign Name In Full

Driver Identification NumberSocial Security Number

Last Name2.FirstMIDate of Birth (Month/Day/Year)

TitlePercentage of Stock

Residence Phone No. (Area Code)

( )

Residence Address (Include Number and Street)

Please Sign Name In Full

Driver Identification NumberSocial Security Number

Last Name3.FirstMIDate of Birth (Month/Day/Year)

TitlePercentage of Stock

Residence Phone No. (Area Code)

( )

Residence Address (Include Number and Street)

Please Sign Name In Full

Driver Identification NumberSocial Security Number

CHECK ONE

YES NO

G. Services Offered - Attach a list of services you will provide and the prices for these services. You must include the fee and

duration of each lesson.

Last NameFirst

CityStateZIP

Residence Address (Include Number and Street)

Title

Last NameFirst

CityStateZIP

Residence Address (Include Number and Street)

www.dmv.ny.gov

MV-521 (9/15)

PAGE 4 OF 7

A.Have you or any person named in this application ever had a financial interest in a DMV-regulated business that had its license,

registration or certification denied, suspended or revoked in New York State? This includes an interest as owner, partner, corporate

officer, managing member or stockholder holding more than twenty percent of the stock, and includes matters now on appeal.

oNO oYES

If “YES”: Specify name and address of the person(s), business type, date and action taken against the business.

C.Have you or any person named in this application been convicted of, or forfeited bail for, any misdemeanor or felony at any

time?

oNO oYES

If “YES”: Name _________________________________________________________ Date of Birth______________

Conviction Date __________________ Penalty _____________ Court ________________________________________

Attach copy of Certificate of Conviction, and explain nature of offense (Further explanation may be attached.)

D.Does anyone else have a financial interest in your business that is not disclosed on this application? oNo oYes

If “YES”: Name ________________________________________________________________________________

E. Do you have any employees?

oYES oNO

If “YES”: provide your Federal Employer Identification Number______________________, and attach a copy of proof of

Worker’s Compensation (form C-105.2 or U-26.3) and Disability Benefits Insurance (form DB-120.1) coverage from the NYS

Insurance Fund: www.nysif.com or (212) 312-9000

If “NO”: you can submit either proof of worker’s compensation and disability benefits (as above) or a Certification of

Attestation of Exemption (form CE-200) available at www.labor.ny.gov

B. Are you, or is anyone named in this application, scheduled for a hearing that may result in the suspension, revocation

or denial of a DMV-issued business license or approval for a DMV-approved course (such as PIRP, Motorcycle Safety

Program Beginner Rider Course, PSB, etc.)? oNO oYES

If “YES”: Specify name and address of the person(s), business type, date and reason for hearing.

Tell us about your business and associates:PART 5

NAME OF DRIVING SCHOOL: ______________________________________________________________________________

Attach additional pages if necessary

PART 6

Additional Information (please identify the section name and/or question number related to the additional information you are providing).

www.dmv.ny.gov

MV-521 (9/15)

PAGE 5 OF 7

Certification (all applicants must complete this section):PART 7

Send this form and all papers required to complete your application package to:

NYS Department of Motor Vehicles

Bureau of Driver Training Programs

Certification & Oversight Unit

6 Empire State Plaza

Albany NY 12228

(518) 473-7174

NOTE

: If you are applying for a license to open a driving school or a branch office, or to change your ownership or address, this

application package is the first part of a two-part process. After your application and supporting documents are received and

accepted (see page 2 of form MV-299.2), a Motor Vehicles License Examiner will visit your driving school/branch premises to

conduct an inspection.

Application Prepared by

________________________________ ______________________________ ___________________ ____________

The person(s) signing this application states that he or she is an owner, partner, officer, or managing member of the business named on this

application, and that all information provided in this application is true. To knowingly make a false statement in this application is a misdemeanor

punishable under Section 210.45 of the Penal code, and may result in the revocation of your driving school license. Making a false statement

in this application or in any proof or statements in writing in connection with it, or deceiving or substituting in connection with this

application is a misdemeanor under Section 392 of the Vehicle and Traffic Law, and may also result in the revocation or suspension of

your driving school license.

Signature of Owner or Corporate Officer or Managing Member

TitleDate

Signature of Owner or Corporate Officer or Managing Member

TitleDate

Signature of Owner or Corporate Officer or Managing Member

TitleDate

Signature of Owner or Corporate Officer or Managing Member

TitleDate

Signature of Owner or Corporate Officer or Managing Member

TitleDate

Signature of Owner or Corporate Officer or Managing Member

TitleDate

Print Name

SignatureTitleDate

You must meet all requirements to be approved.

Have you completed ALL SECTIONS that apply to your business?

lHave you signed the application?

Have you included your check (NO STARTER CHECKS) or money order for the application fees, made payable to

“Commissioner of Motor Vehicles “?

As a condition for the issuance and the continued validity of a driving school license, the individuals signing this

application agree to the following conditions:

to comply with all of the provisions of the New York State Vehicle and Traffic Law and the Commissioner’s Rules

and Regulations relating to driving schools and Private Service Bureaus.

to comply with all state laws and regulations, and all municipal ordinances and regulations relating to public

health and public safety for the school and business facility.

to employ (or otherwise make use of) only instructors who have been properly certified by the State of New York

to instruct at the applicant’s school.

NAME OF DRIVING SCHOOL: ______________________________________________________________________________

www.dmv.ny.gov

MV-521 (9/15)

PAGE 6 OF 7

Tell us your business structure (how you set up the business to operate your drivers’ school). The documentation you include

with your application will depend on your business structure. See the list below for the documentation you must include with

your application:

oSole Proprietor: Certified copy of the Business Certificate by the County Clerk’s Office

oPartnership: Certified copy of the Business Certificate for Partners by the County Clerk’s Office

oCorporation:

Certified copy of the Certificate of Incorporation Filing Receipt (issued by Department of State)

¢If the corporation is a dba with another name, then the applicant must also submit the certificate of assumed

name (issued by Department of State).

Minutes of the corporation meeting that identify:

¢When the meeting was held

¢Who was in attendance

lMinutes must be signed by all officials of the corporation and

lMinutes must be notarized OR have a corporate seal

¢The purpose of the formation of the corporation (to conduct the business of the driver’s school in

accordance with VTL 394)

¢Location of the place of business

¢Corporate officers (CEO, President, VP, Secretary, Treasurer, Corporate Officers)

¢Distribution of shares (including total number of shares) of the corporation and to whom they are

distributed. NOTE: All shares do not have to be distributed, but at least one officer must own a

minimum of 20% of the total shares distributed.

lPerson who is responsible for the operation must have at least 20% of the shares

lNOTE: The filing receipt identifies the number of shares.

oL.L.C. (Limited Liability Company):

Certified copy of the Certificate of Incorporation (issued by Department of State)

Minutes of the company meeting that identify:

¢When the meeting was held

¢Who was in attendance (i.e. the members)

lMinutes must be signed by all members of the company and

lMinutes must be notarized OR have corporate seal

¢The purpose of the formation of the company to conduct the business of the driver’s school in

accordance with VTL 394

¢Location of the place of business

¢Members of the L.L.C., and their respective titles

ADDITIONAL INFORMATION:

School InformationPART 1

PART 4

Ownership information

Tell us about your business and associatesPART 5

Employee Benefits Coverage: You must show proof that you have either:

oWorker’s Compensation (form C-105.2 or U-26.3) and Disability Benefits Insurance (form DB-120.1) OR

oCertificate of Attestation of Exemption from NYS Work’s Compensation and/or Disability Benefits Coverage (form CE-200),

found at www.labor.ny.gov

Personal History (form MV-521.1): You must provide this for all staff except instructors.

Required Instructor Verification: You must have at least one certified instructor.

oForm MV-523 Application for Driving School Instructor Certificate (and all supporting documents and fees).

oAt least one instructor must have a minimum of 1,000 hours “behind-the-wheel” teaching experience. A notarized statement

is required to verify this experience. If a notarized statement is not available, we’ll review any personal statement with

supporting documentation.

Non-refundable application fee:Only applications for an ORIGINAL or CHANGE OF OWNERSHIP require an application fee.

The fee is fifty dollars ($50) and must be paid in the form of a check (no starter checks can be accepted) or money order, made

payable to “Commissioner of Motor Vehicles.”

www.dmv.ny.gov

MV-521 (9/15)

PAGE 7 OF 7

Place of Business

PART 6

General Information

Proof of location for business: Your driving school must have a physical office (which DMV will inspect before a license is

issued). As part of the application, you must include proof of your office location by including a copy of a deed or lease or

sublease. You must also include a copy of the certificate of occupancy.

NOTE: if this is a sub-lease, you must submit a copy of the rental lease issued to the tenant and a written statement from the

landlord, which acknowledges the approval of the presence of a driving school at the location.

Required Driving School Records. A driving school is required to keep records of business and customers. With your

application you must submit a draft copy of:

oStudent Record Card

oBusiness Receipt and/or

oContract(s) the school will use - optional

oPrivate Service Bureau (PSB) receipt if the business intends to operate a PSB - optional

List of Driving School Vehicles (form MV-527). All vehicles used for training or road testing must be reported. Even if the

school has no vehicles, the MV-527 is required and must indicate “no vehicles.”

Prelicensing Course (optional): A driving school which provides the DMV Prelicensing Course must have an approved

classroom and qualified “classroom-endorsed” instructor.

oInclude Premises Check (form MV-279) and

oProof of Location of classroom (if at a different location), consisting of a deed or lease or sublease NOTE: if this is a

sub-lease, you must submit a copy of the rental lease issued to the tenant and a written statement from the landlord,

which acknowledges the approval of the presence of a driving school at the location.

oAuthorized Signature List (form MV-278.6)

Application for Access to DMV Internet Road Test Scheduling System (form MV-522.1) (optional). All driver license testing

with DMV is scheduled using an automated scheduling system. Driving schools can apply for an account that allows them to

schedule appointments for their customers.

www.dmv.ny.gov

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