Fillable Printable Form MV-65 - Vehicle Escort Driver Application - New York

Form MV-65 - Vehicle Escort Driver Application - New York

New York State Department of Motor Vehicles

VEHICLE ESCORT DRIVER APPLICATION

www.dmv.ny.gov

M F

Note: To become a certified vehicle escort driver, you MUST:

l Have a valid driver license l Pay a $40 fee l Present proof of ID

l Be at least 21 years old l Pass a written exam (as listed on ID-44)

Note: If you are a New York licensed driver and need to change your name and/or address, you must notify DMV of any

change BEFORE you submit this application to the Bus Driver Unit.

If you are applying for a replacement or need to change your name and/or address on your certificate, complete this form

and mail it to: NYS Department of Motor Vehicles, Bus Driver Unit, 6 Empire State Plaza, Room 136B, Albany,

New York 12228. A $5.00 check (payable to the Commissioner of Motor Vehicles) is required for a replacement certificate.

If you are applying for a renewal, complete this form and mail it to: Department of Motor Vehicles, 207 Genesee Street,

Utica, NY 13501-2874. A $40 check (payable to Commissioner of Motor Vehicles) is required for a renewal.

Month Day Year

o Original Certification o Renewal o Replace Certificate o Amend Certification

Name of Applicant (Last, First, Middle)

Phone Number (Include area code)

Action Wanted:

Date of Birth

Client ID number as it appears on your

NYS Vehicle Escort card (if available)

State/Province of

driver license Driver License Number

Address Where You Get Your Mail (Include Street Number and Name, Rural Delivery, and/or Box) Apt. #

City or Town State Zip Code County

FEET INCHES

Height

Eye Color

Address Where You Live - If different from your mailing address

(Include Street Number and Name, Rural Delivery, and/or Box) Apt. #

City or Town State

Name Change:

Print your former name exactly as it appears on your escort certificate

Zip Code County

Other Change: What is the change and the reason for it ( wrong date of birth, etc.)?

MV-65 (12/14)

Sex

DMV USE ONLY

Approved

Expiration

Date

Proof Submitted:

o Driver License/ID

Fee

Office

Date:

Address Change for: o Mailing Address o Legal Address

Does any of the information

on your Escort Certificate

have to be changed?

o Yes o No

I state that the information I have given on this application is true to the best of my knowledge. I certify that I am the holder of a valid driver

license that is not now suspended or revoked, and that I have not lost my privilege to drive in New York State.

SIGN HERE

ç ___________________________________________________________

(Sign name in full - A married woman must use her own first name.)

PLEASE PRINT WITH BLUE OR BLACK INK IN THE BOXES