Form MV-44B "Application for Permit, Driver License or Non-driver Id Card" - New York (Bengali)

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PRINT CLEARLY IN BLUE OR BLACK INK.
This form
is also available at
APPLYING FOR:
PURPOSE FOR APPLICATION:
License
Permit
ID card
New
Renew
Update Info
Change Type
Replacement
Conditional
Restricted
Transfer to New York
IDENTIFICATION INFORMATION
Do you now have, or did you ever have a New York
driver license, learner permit, or non-driver ID card?
Yes
No
Applying for a Non-Driver ID card will cancel any New York State driver license privilege.
FULL LAST NAME
FULL FIRST NAME
FULL MIDDLE NAME
SUFFIX
DATE OF BIRTH
Month
Day
Year
Do you have or did you ever have a driver license that is valid or that
expired within the last two years, issued by another U.S. State, the
District of Columbia or a Canadian Province?
Yes
No
If “Yes”, where was it issued?
Date of Expiration: Type of License:
Out-of-State License ID No.:
GENDER
HEIGHT
M a le
Female
Feet
Inches
EYE COLOR
TELEPHONE NUMBER (Home/Mobile)
Area Code
Has your name changed?
Yes
No
If “Yes”, print your former name exactly as it appears on your present license or non-driver ID card.
OTHER CHANGE:
What is the change and the reason
for it (new license class, wrong date of birth, etc.)?
SOCIAL SECURITY NUMBER
If you have never been issued a Social Security Number, check this box
If you were ever issued an
you must provide the number. Authority to collect your SSN is
you
you
were ever
The information will be used for
granted by
with
jurisdictions, to assist in verification of identity, and for driver license sanctions
If you were ever issued an
will not be given to the public.
ADDRESS WHERE YOU GET YOUR MAIL
- Include Street Number and Name, Rural Delivery and/or box number (If PO Box, also fill in “Address Where You Live” below)
Apt. No.
Apt. No.
City or Town
City or Town
State
State
Zip Code
Zip Code
County
County
HAS YOUR MAILING ADDRESS CHANGED?
Yes
No
HAS THE ADDRESS WHERE YOU LIVE CHANGED?
Yes
No
If you answered yes to either of the questions above, then addresses on all vehicle registrations tied to your ID number will also be updated with this address, unless you check this
box
. If you are registered to vote, your voter registration record will be updated when you complete and submit this form. If you do NOT want your new address on your
voter registration record,
you do not check the box, your new address will be sent to the Board of Elections of your county of residence.
VETERAN
STATUS
Check this box if you would like to have “Veteran” printed on the front of your photo document.
You must present proof that indicates an honorable discharge from military service (ex: DD-214, DD-215).
NEW YORK STATE ORGAN AND TI S SUE DONATION (You must fill out this section)
To enroll in the New York State Donate
Registry, check the “yes” box and then sign and date
below. You are certifying that you are:
years of age or older; consenting to donate your organs and
tissues for transplantation and research; authorizing
to transfer your name and identifying
information to the Donate Life Registry; and authorizing Donate Life New York State to give access to
this information to federally regulated organ
organizations and
will be printed on the front of
to limit your donation. If you are 16 or 17 years of age, parents/legal guardians may change your
decision upon your death. For more information,
contact
York State
Check this box to make a $1 voluntary donation to the Life...Pass It On Trust Fund for organ
and tissue donation research and outreach. Your total transaction fee will include the $1.
You must answer the following question
Would you like to be added to the Donate Life Registry?
Yes (sign and date consent below)
Skip This Question
Donor Consent Signature and Date
VOTER REGISTRATION
QUESTIONS
(Please check ‘Yes’ or ‘No’.)
If you are not registered to vote where
you live now, would you like to apply to
you live now, would you like to apply to
register?
YES - Complete Voter Registration Application Section
(Not necessary if you bring this form to a DMV office).
NO - I Decline to Register/Already Registered
NO - I Decli n e to Regi s ter/Already Regi s tered
NOTE: If you do not check either box,
you will be considered to have decided
not to register to vote.
REGISTRATION WITH THE UNITED STATES
REGISTRATION
All male U.S. citizens and immigrants ages 18 through 25 must register with SSS or violate the law. Failure to register is a felony punishable by up to five years in prison
and/or a $250,000 fine. If not registered by age 26, you can no longer register and will permanently lose benefits associated with registration, and you will be disqualified
from access to: U.S. citizenship if an immigrant; Pell Grants and federal student aid; job training programs; and all federal and postal jobs and many state employment jobs
Should you elect not to register you may do so by checking the “No” box and the pre-mentioned benefits will be lost.
NO
PLEASE COMPLETE AND SIGN PAGE 2
ADDRESS WHERE YOU LIVE
REQUIRED IF DIFFERENT FROM ADDRESS FOR MAIL DO NOT GIVE P.O. BOX. THIS ADDRESS WILL APPEAR ON YOUR ENHANCED/REAL ID IDENTITY DOCUMENT
*
MV-44B (10/20)
3
1
OFFICE USE ONLY
dmv.ny.gov
Image #
?
(
)
* (SOCIAL SECURITY NUMBER, SSN)
*
SSN
(Vehicle
and Traffic Law)
490(3)
502(1)-
SSN
V&T
510(4-e)
510(4-f)
SSN
-
-
LifeSM
16
DMV-
DMV
(ORGAN DONOR)’’
donatelife.ny.gov e
DL
DMV
(SELECTIVE SERVICE SYSTEM, SSS)
OFFICE USE ONLY
License
Special
NI
NA
EI
EA
CDL Certifications
TEENS
Class
Conditions
Approved By
Date
Office
Other
Restrictions
PRINT CLEARLY IN BLUE OR BLACK INK.
This form
is also available at
APPLYING FOR:
PURPOSE FOR APPLICATION:
License
Permit
ID card
New
Renew
Update Info
Change Type
Replacement
Conditional
Restricted
Transfer to New York
IDENTIFICATION INFORMATION
Do you now have, or did you ever have a New York
driver license, learner permit, or non-driver ID card?
Yes
No
Applying for a Non-Driver ID card will cancel any New York State driver license privilege.
FULL LAST NAME
FULL FIRST NAME
FULL MIDDLE NAME
SUFFIX
DATE OF BIRTH
Month
Day
Year
Do you have or did you ever have a driver license that is valid or that
expired within the last two years, issued by another U.S. State, the
District of Columbia or a Canadian Province?
Yes
No
If “Yes”, where was it issued?
Date of Expiration: Type of License:
Out-of-State License ID No.:
GENDER
HEIGHT
M a le
Female
Feet
Inches
EYE COLOR
TELEPHONE NUMBER (Home/Mobile)
Area Code
Has your name changed?
Yes
No
If “Yes”, print your former name exactly as it appears on your present license or non-driver ID card.
OTHER CHANGE:
What is the change and the reason
for it (new license class, wrong date of birth, etc.)?
SOCIAL SECURITY NUMBER
If you have never been issued a Social Security Number, check this box
If you were ever issued an
you must provide the number. Authority to collect your SSN is
you
you
were ever
The information will be used for
granted by
with
jurisdictions, to assist in verification of identity, and for driver license sanctions
If you were ever issued an
will not be given to the public.
ADDRESS WHERE YOU GET YOUR MAIL
- Include Street Number and Name, Rural Delivery and/or box number (If PO Box, also fill in “Address Where You Live” below)
Apt. No.
Apt. No.
City or Town
City or Town
State
State
Zip Code
Zip Code
County
County
HAS YOUR MAILING ADDRESS CHANGED?
Yes
No
HAS THE ADDRESS WHERE YOU LIVE CHANGED?
Yes
No
If you answered yes to either of the questions above, then addresses on all vehicle registrations tied to your ID number will also be updated with this address, unless you check this
box
. If you are registered to vote, your voter registration record will be updated when you complete and submit this form. If you do NOT want your new address on your
voter registration record,
you do not check the box, your new address will be sent to the Board of Elections of your county of residence.
VETERAN
STATUS
Check this box if you would like to have “Veteran” printed on the front of your photo document.
You must present proof that indicates an honorable discharge from military service (ex: DD-214, DD-215).
NEW YORK STATE ORGAN AND TI S SUE DONATION (You must fill out this section)
To enroll in the New York State Donate
Registry, check the “yes” box and then sign and date
below. You are certifying that you are:
years of age or older; consenting to donate your organs and
tissues for transplantation and research; authorizing
to transfer your name and identifying
information to the Donate Life Registry; and authorizing Donate Life New York State to give access to
this information to federally regulated organ
organizations and
will be printed on the front of
to limit your donation. If you are 16 or 17 years of age, parents/legal guardians may change your
decision upon your death. For more information,
contact
York State
Check this box to make a $1 voluntary donation to the Life...Pass It On Trust Fund for organ
and tissue donation research and outreach. Your total transaction fee will include the $1.
You must answer the following question
Would you like to be added to the Donate Life Registry?
Yes (sign and date consent below)
Skip This Question
Donor Consent Signature and Date
VOTER REGISTRATION
QUESTIONS
(Please check ‘Yes’ or ‘No’.)
If you are not registered to vote where
you live now, would you like to apply to
you live now, would you like to apply to
register?
YES - Complete Voter Registration Application Section
(Not necessary if you bring this form to a DMV office).
NO - I Decline to Register/Already Registered
NO - I Decli n e to Regi s ter/Already Regi s tered
NOTE: If you do not check either box,
you will be considered to have decided
not to register to vote.
REGISTRATION WITH THE UNITED STATES
REGISTRATION
All male U.S. citizens and immigrants ages 18 through 25 must register with SSS or violate the law. Failure to register is a felony punishable by up to five years in prison
and/or a $250,000 fine. If not registered by age 26, you can no longer register and will permanently lose benefits associated with registration, and you will be disqualified
from access to: U.S. citizenship if an immigrant; Pell Grants and federal student aid; job training programs; and all federal and postal jobs and many state employment jobs
Should you elect not to register you may do so by checking the “No” box and the pre-mentioned benefits will be lost.
NO
PLEASE COMPLETE AND SIGN PAGE 2
ADDRESS WHERE YOU LIVE
REQUIRED IF DIFFERENT FROM ADDRESS FOR MAIL DO NOT GIVE P.O. BOX. THIS ADDRESS WILL APPEAR ON YOUR ENHANCED/REAL ID IDENTITY DOCUMENT
*
MV-44B (10/20)
3
1
OFFICE USE ONLY
dmv.ny.gov
Image #
?
(
)
* (SOCIAL SECURITY NUMBER, SSN)
*
SSN
(Vehicle
and Traffic Law)
490(3)
502(1)-
SSN
V&T
510(4-e)
510(4-f)
SSN
-
-
LifeSM
16
DMV-
DMV
(ORGAN DONOR)’’
donatelife.ny.gov e
DL
DMV
(SELECTIVE SERVICE SYSTEM, SSS)
OFFICE USE ONLY
License
Special
NI
NA
EI
EA
CDL Certifications
TEENS
Class
Conditions
Approved By
Date
Office
Other
Restrictions
THESE QUESTIONS MUST BE COMPLETED FOR ALL LICENSE/PERMIT TRANSACTIONS
Has your driver license, learner permit, or privilege to drive a motor vehicle
been suspended, revoked or cancelled, or has your application for a license
been denied in this state or elsewhere, in the name you provide on this form
or any other name?
Yes
No
If “Yes”, has your license, permit or privilege been restored, or has your
application been approved?
Yes
No
Have you received treatment, do you currently receive treatment, or do you
take medication for any condition that causes unconsciousness or
dizziness, or a heart condition)?
Yes
No
If you marked “Yes”, you must submit form MV-80U.1, even if you were
released from the
You can get this form at any
or
Vehicles office or at
Do you need a hearing aid and/or full view mirror to drive a motor vehicle?
to drive a motor vehicle?
Yes
No
Have you lost the use of a leg, arm, hand or eye?
Yes
No
If you need to renew your driver license and you marked “Yes”, did this
occur since your last driver license?
Yes
No
you
has your condition gotten worse since your
last driver license?
Yes
No
Junior License
Non-driver ID Card
under
I am the parent or guardian of the applicant, and I consent to the issuance of a learner permit, license or (if under 16) a non-driver ID card to him/her. I understand
that I am responsible for certifying that the applicant has completed at least 50 hours of supervised “practice” driving, including 15 hours of driving after sunset,
prior to the applicant taking a road test, and that this certification (form MV-262) must be presented at the time of the road test. Note to parent/guardian:
driver license applicant is 17 years old and has a Driver Education Student Certificate of Completion (form MV-285), consent is not required.
Parent or Guardian
Sign Here
(Relationship to Applicant)
(Date)
Teen Electronic Event Notification Service
would
program to be notified if the under 18 year-old applicant
receives a conviction, suspension, revocation or an accident on their license file. For more
information
information
How to Enroll in
service.
This is a FREE service.
ID Number on New York State Driver License, Permit or
Non-driver ID Card of Consenting Parent or Guardian
Above (Required)
COMMERCIAL DRIVER LICENSE APPLICANTS ONLY
In the past 10 years, was a driver license issued to you from another state in the U.S. or the District of Columbia ?
Yes
No
If YES, write the name of each one
You MUST certify to DMV that you operate (or expect to operate) a commercial motor vehicle in one of the following four driving types (select only one):
four driving types (select only one):
Non-excepted Interstate (NI) - Certified medical status is required. You
are age 21 or older and you operate, or expect to operate, interstate
(other than for excepted operation).
Non-excepted Intrastate (NA) - Certified medical status is required. You
are age 18 or older and you operate, or expect to operate, in New
York State only (other than for excepted operation).
Excepted Interstate (EI) -You are age 18 or older and you operate, or
expect to operate, interstate in Excepted Operation ONLY. You must
have A3 restriction.
Excepted Intrastate (EA) - You are age 18 or older and you operate, or
expect to operate, in Excepted Operation ONLY and in New York State
ONLY. You must have A3 and K restrictions.
If the driving type you selected requires certified medical status (NI or NA) you must provide a legible copy of your current USDOT Medical Examiner’s
Certificate to DMV if it is not already on file. Please see DMV form MV-44.5 if additional information is needed to help you determine your driving type.
If the driving type you
CERTIFICATION
I certify that the information I have given on this application and on any documentation provided in support of this application is true and complete.
I understand that making a false statement on this application, or submitting any documentation in support of this application that is false, may be punishable as
If I am applying for a replacement document, I certify that my New York State document has been lost, stolen, or mutilated.
If I am transferring an Out-of-State Driver License to a New York State Driver License, I certify that, when I obtained my out-of-state driver license, I was a
permanent resident of the state or province that issued the license, that license has been valid for at least 6 months, and I have not failed a driving skills road
test in New York State in the last 12 months.
If I am applying for a Conditional or Restricted Use License, I certify that I will pay the full tuition and other required fees for the rehabilitation program (if
applicable), attend the program (if required), and will drive within the conditions required for the restricted or conditional license. I understand that failure to do
so will result in the revocation of my restricted or conditional license and the reinstatement of the suspension or revocation against my full license.
If I am a male at least 18 but less than 26 years old, unless I have opted "no" to United States Selective Service System (SSS) registration on Page 1, I hereby
affirmatively opt to register with the SSS and consent to DMV forwarding my personal information to the SSS for registration.
SIGN HERE
PLEASE PRINT NAME
DATE:
PAGE 2 OF 3
1.
3.
4.
4a.
2.
4b.
4a-
MV-80U.1
dmv.ny.gov-
(16
)
X
(Teen Electronic Event Notification Service, TEENS)
TEENS
TEENS e
a
MV-1046,
MV-1056,TEENS FAQs
 
1.
2.
(Non-excepted Interstate, NI) -
(Excepted Interstate, EI) -
(Excepted Intrastate, EA) -
(Non-excepted Intrastate, NA) -
X
/
/
`
EYE TEST RESULTS
Applicant’s Signature
Examiner’s Initials
OFFICE
USE
Passed in Office
Vision Registry
Corrective Lens
3
2
MV-44B (10/20)
NEW YORK STATE VOTER REGISTRATION APPLICATION INFORMATION
(Please read before you complete application on the other side.)
Use the NYS Voter Registration Application
to Register to Vote in NYS Elections, and/or:
change the name or address on your voter registration
become a member of a political party
change your party membership
pre-register to vote if you are 16 or 17 years of age
To Register You Must:
be a U.S. citizen
be 18 years old (you may pre-register at 16 or 17 but cannot vote until you are 18)
be a U.S. citizen
not be in prison or on parole for a felony conviction (unless parole pardoned
or restored rights of citizenship)
not claim the right to vote elsewhere
not found to be incompetent by a court
If you do not complete the New York State Voter Registration Application, you will be considered to have declined to register to vote. If
you decline to register to vote, the fact that you have declined to register will remain confidential and will be used only for voter
registration purposes. If you do register to vote, the office at which you submit a voter registration application will remain confidential
and will only be used for voter registration purposes. If you believe that someone has interfered with your right to register or decline to
register to vote, your right to privacy in deciding whether to register or in applying to register to vote, or your right to choose your own
(phone:
Your completed application will be sent to the Board of Elections and you will be notified by your County Board of Elections when your
application has been processed. If you have any questions about filling out the voter registration application or registering t
Your completed application will be sent to the Board of Elections and you will be notified by your County Board of Elections wh
oose your own
Your completed application will be sent to the Board of Elections and you
oose your own
Información en español: si le interesa obtener este
formulario en español, llame al 1 -800-367-8683
中文資料:若
有興趣索取中文資料表格,
請電:
1-800-367-8683
한국어: 한국어 양식을 원하시면
1-800-367-8683
으로 전화 하십시오.
Información en español: si le interesa obtener este
formulario en español, llame al 1 -800-367-8683
NEW YORK STATE VOTER REGISTRATION APPLICATION
Only fill this out if you want to register to vote or change your address or other information with the Board of Elections.
Are you a citizen of the U.S.?
Yes
No
If you answer NO,
If you answer NO,
you cannot register to vote.
Have you voted
before?
Yes
No
What Year?
More Information
(Optional)
Email
Will you be 18 years of age or older on or before election day?
Yes
No
Are you at least 16 years of age and understand that you must be 18 years of age on or before election day to vote, and that until you will be eighteen years
of age at the time of such election your registration will be marked “pending” and you will be unable to cast a ballot in any election?
Yes
No
If you answer NO to both of the prior questions, you cannot register to vote.
Voting information that
has changed:
Skip if this has not changed or
you have not voted before.
Your name was
Your address was
Your state or New York State County was:
Telephone Number
Political Party
You
must
make
1
selection. Political party
enrollment is optional
but that, in order to vote
in a primary election of
a political party, a voter
must enroll in that
political party unless
state party rules allow
state party rules allow
otherwise.
I wish to enroll in a political party:
Democratic party
Republican party
Conservative party
Working Families party
Green party
Libertarian party
Independence party
party
Other:
I do not wish to enroll in any political party and wish
to remain an independent voter
No party
AFFIDAVIT: I swear or affirm that
I am a citizen of the United States.
I will have lived in the county, city, or village for at least 30 days before the election.
I meet all requirements to register to vote in New York State.
This is my signature or mark on the line below.
The above information is true. I understand that if it is not true, I can be convicted
and fined up to $5,000 and/or jailed for up to four years.
Sign
Date
PAGE 3 OF 3
OFFICE USE ONLY
18
: NYS
Board of Elections, 40 North Pearl Street, Albany, NY 12207-2729 (
: 1-800-469-6872)।
1-800-FOR-VOTE (TDD/TTY Dial
711)
1-866-VOTE-NYC
: www.elections.ny.gov
?
?
$5,000
SAM
X
_______________________________________
________________
MV-44B (10/20)
Page of 3