Fillable Printable Form MV-522 - Driving School Renewal Application - New York

Form MV-522 - Driving School Renewal Application - New York

DMV USE ONLY

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ANSWER ALL QUESTIONS - CHECK ONE

Yes No

1. Has there been any change of owner, partner, corporate officer, major stockholder or manager of the driving school?

[If “yes”, attach completed Personal History (form MV-521.1)] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o o

2. Has there been any change in driving school courses or fees charged since your last application?

(Attach schedule of fees.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o o

3. Has your driving school license been suspended or revoked since last issued? (If “yes”, attach sheet with explanation.) . . . . . . . o o

4. Have any of the owners, partners, corporate officers, managers or major stockholders been convicted of a crime or felony

involving violence, dishonesty, deceit, indecency, degeneracy or moral turpitude? (If “yes”, attach sheet with explanation.)

o o

5. Has there been any change in your business address or a branch office address since your license was last issued?

(If “yes”, attach new address.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o o

6. Does your school offer the Prelicensing Course? [If “yes”, attach a list of all classrooms you use for this course, list all languages

in which the course is taught, and attach an updated Authorized Signature List (Prelicensing Course, form MV-278.6)]. . . o o

7. Does your school offer a Point Insurance Reduction Program? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o o

(If “yes”, provide the sponsor’s name:__________________________________________________________________.)

8. Are you under contract to provide the in-car portion of the driver education course for any school?

(If “yes”, attach sheet with explanation including a list of all contracts) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o o

9. What type(s) of vehicles are you using for instruction?

o Auto o Bus o Motorcycle o Tractor-Trailer o Truck

Workers’ Compensation Law (Section 57) and the Disability Benefits Law (Section 220, subdivision 8) require you to provide proof that you

have obtained the appropriate workers’ compensation and disability benefits insurance coverage for any paid and unpaid employees.

10. Attach Workers’ Compensation form o C-105.2 OR U-26.3 AND Disability Benefits form o DB-120.1

Attach a signed copy of form CE-200, Application for Certificate of Attestation of Exemption.

Remember To Attach Copies of Your Forms

DRIVING SCHOOL RENEWAL APPLICATION

License

Number

Date

Received

Fee

Expiration

Date

Please print or type. With this application, send a current schedule of fees, a List of Driving School Vehicles (MV-527), and proof of workers’

compensation

and disability benefits insurance coverage. You must also send documentation of any changes in personal history

information, instructor status, or powers of attorney.

Address of

School

Phone Number

Federal

ID Number

Branch Name

and Address

Branch Name

and Address

Type of Business (Check one of the following)

o Sole Proprietorship o Partnership o Corporation o Other (describe) ___________________________________

Name of Driving

School

City State Zip Code

First M.I.

MV-522 (9/15)

PAGE 1 OF 2

Last Name of

Owner

Social Security

Number

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

If the school has a website, please provide the website address.

Phone Number

Fax Number

Last Name

E-mail Address Driving School Website Address

First

M.I.

If more than

2 branches,

attach additional

sheet

NOTE: Businesses regulated by the Department of Motor Vehicles are required to provide their Social Security numbers and Federal ID numbers to

the Department of Taxation and Finance, upon request, for tax administration purposes pursuant to Section 5 of the New York State Tax Law.

All of the individuals signing this application affirm that they have read the entire application, that they are familiar with all of its contents, and

that all answers and statements made in connection with this application are true. Each owner, partner, corporate officer, and major

stockholder (20% or more) of the driving school must sign

in the space provided below.

To knowingly make a false statement or conceal a material fact in this application is a criminal offense, and may result in

the revocation of your driving school license. False statements are punishable under Section 210.45 of the Penal Code.

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

BUREAU OF DRIVER TRAINING PROGRAMS

CERTIFICATION AND OVERSIGHT

NYS DEPARTMENT OF MOTOR VEHICLES

6 EMPIRE STATE PLAZA

ALBANY NY 12228

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:

u to comply with all of the provisions of the New York State Vehicle and Traffic Law and the rules and regulations relating to driving

schools and Private Service Bureaus.

u 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.

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

applicant’s school.

Application Prepared by:

Print Name

Signature Title Date

FEES

Make check or money order payable to the Commissioner of Motor Vehicles

u Driving School one-year renewal: $50 u Branch Office one-year renewal: $1.50

u Driving School two-year renewal: $100 u Branch Office two-year renewal: $3.00

MV-522 (9/15)

Signature (Owner or Corporate Officer) Title Date

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Name of Driving School: ___________________________________________________________________________________

www.dmv.ny.gov

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