Form MV-45A "Statement of Identity and/or Residence for Applicants Represented by Government or Government-Approved Facilities" - New York

What Is Form MV-45A?

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 December 1, 2019;
  • 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 fillable version of Form MV-45A 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-45A "Statement of Identity and/or Residence for Applicants Represented by Government or Government-Approved Facilities" - New York

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STATEMENT OF IDENTITY AND/OR RESIDENCE
For Applicants Represented by Government or Government-Approved Facilities
dmv.ny.gov
This document is used for identity and/or residence only and cannot be used for proof of date of birth.
Proof of Date of Birth and Social Security requirements must be met.
This statement may only be used by an applicant who is mentally or physically challenged, is represented by a government or government-
approved facility, AND who cannot provide sufficient proof of:
ä
Identity from the proofs listed on form ID-44 (How to Apply for a New York: Learner Permit, Driver License, Non-Driver ID Card); and/or
ä
Residence from the proofs listed on form ID-44 (How to Apply for a New York: Learner Permit, Driver License, Non-Driver ID Card).
Please note: Proof of residence is required with all drivers permits and license. If applying for a REAL
ID document or an enhanced
document, an additional proof of residency is required.
The applicant and the approved facility representative may use the following method for PROOF OF NAME AND/OR RESIDENCE:
ä
The approved representative
must accompany the applicant
when the applicant applies for a permit/ID card and
must sign this
form in the presence of a Motor
Vehicle Representative.
ä
The applicant’s representative must be a government or government-approved facility representative, and must provide the
representative’s original facility ID card/document along with a letter on the facility’s letterhead, signed by the representative’s
supervisor. This letter must verify the applicant’s name, date of birth, address, height, eye color, the name of the facility and the name of
the representative. If the letter is
submitted from a government-approved facility, the letter must indicate the name of the New York State
facility and the
facility’s certificate number.
ä
The representative must have a valid
Driver License/Permit/or Non-Driver Identification Card, and
New York State Photo
must
show this proof along with the above documents at the time of application.
CERTIFICATION
I,
, certify as the Representative
(Full Name of Representative)
of
, who resides at
(Full Name of Applicant)
(Applicant’s Address)
that this is the applicant’s full name and that the applicant resides at the address above. To the best of my knowledge, the applicant has not
obtained or applied for a learner permit, non-driver identification card or driver license in any other name. I understand that making a false
statement, or submitting any documentation in support that is false, may be punishable as a criminal offense. This certification must be
accompanied by an original letter from the government facility that has approved the applicant’s representative (see above).
IMPORTANT: DO NOT SIGN THIS FORM UNTIL
YOU ARE WITH A MOTOR VEHICLE REPRESENTATIVE.
X
APPLICANT’S REPRESENTATIVE Sign Here
Print Your Name:
Identification No. from your Driver License, Permit or Non-Driver ID Card:
Print Your
Facility’s Name:
Facility’s Phone No.:
Facility’s Mailing
Address:
IMPORTANT: DO NOT SIGN THIS FORM UNTIL
YOU ARE WITH A MOTOR VEHICLE REPRESENTATIVE.
_________________________________________________________
X
APPLICANT Sign Here
OFFICE USE ONLY
Proofs of Identify Presented by Representative (all are required):
NYS Photo Driver License/Permit/Non-Driver ID
••
• •
Government or Government-Approved Facility Letter
Government or Government-Approved Facility ID Card/document
••
••
X
Signature of Person Accepting Proof
Title of Person Accepting Proof:
Office:
Date
Become an Organ Donor! Visit donatelife.ny.gov
MV-45A (8/21)
STATEMENT OF IDENTITY AND/OR RESIDENCE
For Applicants Represented by Government or Government-Approved Facilities
dmv.ny.gov
This document is used for identity and/or residence only and cannot be used for proof of date of birth.
Proof of Date of Birth and Social Security requirements must be met.
This statement may only be used by an applicant who is mentally or physically challenged, is represented by a government or government-
approved facility, AND who cannot provide sufficient proof of:
ä
Identity from the proofs listed on form ID-44 (How to Apply for a New York: Learner Permit, Driver License, Non-Driver ID Card); and/or
ä
Residence from the proofs listed on form ID-44 (How to Apply for a New York: Learner Permit, Driver License, Non-Driver ID Card).
Please note: Proof of residence is required with all drivers permits and license. If applying for a REAL
ID document or an enhanced
document, an additional proof of residency is required.
The applicant and the approved facility representative may use the following method for PROOF OF NAME AND/OR RESIDENCE:
ä
The approved representative
must accompany the applicant
when the applicant applies for a permit/ID card and
must sign this
form in the presence of a Motor
Vehicle Representative.
ä
The applicant’s representative must be a government or government-approved facility representative, and must provide the
representative’s original facility ID card/document along with a letter on the facility’s letterhead, signed by the representative’s
supervisor. This letter must verify the applicant’s name, date of birth, address, height, eye color, the name of the facility and the name of
the representative. If the letter is
submitted from a government-approved facility, the letter must indicate the name of the New York State
facility and the
facility’s certificate number.
ä
The representative must have a valid
Driver License/Permit/or Non-Driver Identification Card, and
New York State Photo
must
show this proof along with the above documents at the time of application.
CERTIFICATION
I,
, certify as the Representative
(Full Name of Representative)
of
, who resides at
(Full Name of Applicant)
(Applicant’s Address)
that this is the applicant’s full name and that the applicant resides at the address above. To the best of my knowledge, the applicant has not
obtained or applied for a learner permit, non-driver identification card or driver license in any other name. I understand that making a false
statement, or submitting any documentation in support that is false, may be punishable as a criminal offense. This certification must be
accompanied by an original letter from the government facility that has approved the applicant’s representative (see above).
IMPORTANT: DO NOT SIGN THIS FORM UNTIL
YOU ARE WITH A MOTOR VEHICLE REPRESENTATIVE.
X
APPLICANT’S REPRESENTATIVE Sign Here
Print Your Name:
Identification No. from your Driver License, Permit or Non-Driver ID Card:
Print Your
Facility’s Name:
Facility’s Phone No.:
Facility’s Mailing
Address:
IMPORTANT: DO NOT SIGN THIS FORM UNTIL
YOU ARE WITH A MOTOR VEHICLE REPRESENTATIVE.
_________________________________________________________
X
APPLICANT Sign Here
OFFICE USE ONLY
Proofs of Identify Presented by Representative (all are required):
NYS Photo Driver License/Permit/Non-Driver ID
••
• •
Government or Government-Approved Facility Letter
Government or Government-Approved Facility ID Card/document
••
••
X
Signature of Person Accepting Proof
Title of Person Accepting Proof:
Office:
Date
Become an Organ Donor! Visit donatelife.ny.gov
MV-45A (8/21)