Fillable Printable Form NDR-1 - Individual's Request for National Driver Register - New York

Form NDR-1 - Individual's Request for National Driver Register - New York

Proof Submitted o Birth Certificate o Driver License/ID o Credit Card o Passport o Learner Permit o INS Papers

Other:

New York State Department of Motor Vehicles

INDIVIDUAL’S REQUEST FOR

NATIONAL DRIVER REGISTER FILE SEARCH

The National Driver Register (NDR) is a database of information about drivers whose driver licenses have been suspended, revoked, denied or

withdrawn, or who have been convicted of certain serious traffic violations. Any person may ask if there is information about him/her on the

NDR files, whether this information has been disclosed to anyone, and to whom it was disclosed. You will not be listed in the NDR if you have

not had a driver license cancelled, denied, revoked or suspended, or have not been convicted of a serious traffic violation.

NDR search results will be mailed directly to you at the address provided on this form. The NDR will not process your request: if the

information provided on this form is incomplete or cannot be read; or if the form is not signed in the presence of a Motor Vehicles

representative or is not notarized.

The NDR will respond to every processed request, including those where no record is found on file. If a record is found, the full record will be

copied and sent directly to you, including any older records that may have contained a reason for the license cancellation, denial, revocation or

suspension. Also, if the NDR information has been released to anyone, the report will identify who received it. The name and address of the

licensing authority in each state that reported the information will be provided in the report in case you want to ask for more detailed

information about the action reported, or if you need to correct an error. Obtaining specific information about your record, or correcting errors,

can only be done by contacting the state(s) that provided the information to the NDR. You can contact the NDR office Monday through Friday

by calling their toll free number 1-888-851-0436.

INSTRUCTIONS:

u Type or clearly print all information requested.

u The person whose record is being checked must authorize the NDR search by signing this form in the presence of a Motor Vehicles

representative, and must present proof of identity (see form ID-44 for acceptable proofs of identity). You may pre-sign the form,

providing your signature is notarized.

u You may send this form directly to the NDR at the following address:

National Driver Register

1200 New Jersey Ave. S.E.

Washington DC 20590

you may ask a Motor Vehicles office to send your request to the NDR for you. A $10 fee is charged to do this payable by cash, or by check

or money order made payable to the Commissioner of Motor Vehicles.

Last Name

Previous Last Name or Maiden Name

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

City or Town State Zip Code

Driver License Number

(Sign Name in Full)

Date

SIGN HERE ç __________________________________________________________________ Date ____________________________

State Where License was Issued Social Security Number (Optional)

Date of Birth (Mo./Day/Year)

/ /

Sex

oM oF

Height Eye Color

First M.I.

Apt. No.

FOR OFFICE USE ONLY - NOT TO BE COMPLETED BY CUSTOMER

Approved By

(Print Name)

Office

NOTARIZATION —Required only if this form is not

signed in the presence of a Motor Vehicles representative.

Sworn to and ascribed before

me this

______________ day

of________________ in the

year of __________ in the city/

county of__________________

State of___________________

SIGNATURE ç

NDR-1 (3/13)

Notary Public

Seal or Stamp