Form MV-1441.3 "Certification of Lost License, Permit or Plates" - New York

What Is Form MV-1441.3?

This is a legal form that was released by the New York State Department of Motor Vehicles - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2020;
  • The latest edition provided by the New York State Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form MV-1441.3 by clicking the link below or browse more documents and templates provided by the New York State Department of Motor Vehicles.

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Download Form MV-1441.3 "Certification of Lost License, Permit or Plates" - New York

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CERTIFICATION OF LOST LICENSE, PERMIT OR PLATES
Use this form to explain why you cannot turn in your driver license, learner permit, non-driver ID or license
plates to DMV.
DMV may restore your license and/or registration after you serve a suspension or revocation period. When DMV receives this form,
DMV will surrender the item(s) that you check below.
Instructions:
l
Provide all the information requested below. Please print your name and mailing address
exactly as they are printed on
your driver license, learner permit or vehicle registration.
l
Check the box next to each of the items below that you cannot turn in to DMV.
l
In the “Explanation” section, explain why you cannot turn in the item(s) that you check below.
l
Sign your name in the “Customer’s Signature” box, and return this form to any DMV office.
l
If you complete this form, you authorize DMV to surrender the item(s) that you check below (documents and/or license plates).
If you find your suspended/revoked driver license, learner permit, non-driver ID and/or license plates after you give this form to
DMV, you must immediately turn in the item(s) to a DMV office.
/
/
Date of Birth:
Name
(Month/Day/Year)
Mailing Address
License ID #
(or FEIN if
a corporation)
Daytime
(
)
Phone Number:
I cannot turn in the following item(s) to the Department of Motor Vehicles:
o
Photo Driver License
o
Interim/Temporary Driver License or Learner Permit
o
Photo Learner Permit
o
Photo Non-Driver ID
o
License Plates (write the plate number
here)
.
Vehicle Identification Number
Year
Make
l
A police report or a Report of Lost, Stolen or Confiscated Motor Vehicle Items (form MV-78B) is required if you
reported the plates lost or stolen and the registration is not expired. If you requested a police report or form MV-78B
but a police agency denied your request, provide the following:
/
/
Date of Request:
Police Agency/Precinct:
(Month/Day/Year)
l
If one plate is lost, you must turn in the remaining plate.
Explanation:
Certification: Under the penalty of perjury, I certify that, to the best of my knowledge, the explanation above is true.
Customer’s Signature
Date
/
/
X
W A R N I N G :
FALSE STATEMENTS ARE PUNISHABLE UNDER SECTION 210.45 OF THE PENAL CODE. DRIVING
A MOTOR VEHICLE WHILE YOUR LICENSE OR REGISTRATION IS SUSPENDED OR REVOKED IS
A MISDEMEANOR, AND IS PUNISHABLE BY LAW.
MV-1441.3 (6/21)
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CERTIFICATION OF LOST LICENSE, PERMIT OR PLATES
Use this form to explain why you cannot turn in your driver license, learner permit, non-driver ID or license
plates to DMV.
DMV may restore your license and/or registration after you serve a suspension or revocation period. When DMV receives this form,
DMV will surrender the item(s) that you check below.
Instructions:
l
Provide all the information requested below. Please print your name and mailing address
exactly as they are printed on
your driver license, learner permit or vehicle registration.
l
Check the box next to each of the items below that you cannot turn in to DMV.
l
In the “Explanation” section, explain why you cannot turn in the item(s) that you check below.
l
Sign your name in the “Customer’s Signature” box, and return this form to any DMV office.
l
If you complete this form, you authorize DMV to surrender the item(s) that you check below (documents and/or license plates).
If you find your suspended/revoked driver license, learner permit, non-driver ID and/or license plates after you give this form to
DMV, you must immediately turn in the item(s) to a DMV office.
/
/
Date of Birth:
Name
(Month/Day/Year)
Mailing Address
License ID #
(or FEIN if
a corporation)
Daytime
(
)
Phone Number:
I cannot turn in the following item(s) to the Department of Motor Vehicles:
o
Photo Driver License
o
Interim/Temporary Driver License or Learner Permit
o
Photo Learner Permit
o
Photo Non-Driver ID
o
License Plates (write the plate number
here)
.
Vehicle Identification Number
Year
Make
l
A police report or a Report of Lost, Stolen or Confiscated Motor Vehicle Items (form MV-78B) is required if you
reported the plates lost or stolen and the registration is not expired. If you requested a police report or form MV-78B
but a police agency denied your request, provide the following:
/
/
Date of Request:
Police Agency/Precinct:
(Month/Day/Year)
l
If one plate is lost, you must turn in the remaining plate.
Explanation:
Certification: Under the penalty of perjury, I certify that, to the best of my knowledge, the explanation above is true.
Customer’s Signature
Date
/
/
X
W A R N I N G :
FALSE STATEMENTS ARE PUNISHABLE UNDER SECTION 210.45 OF THE PENAL CODE. DRIVING
A MOTOR VEHICLE WHILE YOUR LICENSE OR REGISTRATION IS SUSPENDED OR REVOKED IS
A MISDEMEANOR, AND IS PUNISHABLE BY LAW.
MV-1441.3 (6/21)
reset/clear
reset/clear