Form MV-521 "Driving School License Application" - New York

What Is Form MV-521?

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, 2018;
  • 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;

Download a fillable version of Form MV-521 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-521 "Driving School License Application" - New York

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DMV USE ONLY
DRIVING SCHOOL LICENSE APPLICATION
APPLICATION
LICENSE
No.
No.
Date Received
Fee Amount
Expiration Date
Fee Amount
PART 1
School Information:
l
READ VEHICLE AND TRAFFIC LAW SECTION 394 AND DMV COMMISSIONER’S REGULATIONS PART 76 BEFORE FILLING IN THIS FORM.
l
Print clearly or type.
Name of Driving School
Business Phone No. (Area Code)
Fax Number (Area Code)
(
)
(
)
Address of Main Office
Business Phone No. (Area Code)
Fax Number (Area Code)
Address of Branch Office
(
)
(
)
Contact Information - What is the name, phone number and email address of the individual we should send information to? If the
school has a website, please provide the website address. You must submit a Personal History (form MV-521.1) for this individual.
First
Last Name
Title
E-mail Address
Home Phone No. (Area Code)
Fax Number (Area Code)
Driving School Website Address
(
)
(
)
Application Fee Schedule
Please check the appropriate box below. See also “Additional Information” starting on page 6.
All fees are payable to
“The Commissioner of Motor Vehicles”
o
Original license application* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ 50.00
(non-refundable)
o
Branch license application*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No fee
o
Change of ownership*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ 50.00
(non-refundable)
o
Add Partner(s) or Person(s) to business. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No fee
o
Change of address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No fee
o
Change of business name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No fee
o
Incorporating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No fee
* If your application for an original license or change of ownership is approved, you must pay a license fee of not more than $100 for a two­
year license. If your application for a branch license is approved, the fee is $1.50 per year. The fees are payable to “Commissioner of
Motor Vehicles”, in the form of a check (“starter checks” cannot be accepted) or money order.
PART 2
Check type of ownership (one ownership type per application) and include paperwork described below:
o
Individual with assumed name [sole proprietor or “doing business as” (DBA) name]
Ø
Enclose a copy of the certified business certificate certified by the County Clerk’s office.
o
Partnership with assumed name [“doing business as” (DBA) name]
Ø
Enclose a copy of the Certified Business Certificate for Partners certified by the County Clerk’s office. The partnership
papers must contain all partners’ names and the DBA name.
o
Corporation (Inc., Corp., Ltd.)
Ø
Enclose a copy of the filing receipt issued from the NYS Department of State: (518) 473-2492 or www.dos.ny.gov
Ø
If corporation is a DBA, you must also complete “Corporation with assumed name.”
o
Corporation with assumed name [“doing business as” (DBA) name]
Ø
Print corporation name below and enclose a copy of the Certificate of Assumed Name issued by the NYS Department
of State: (518) 473-2492 or www.dos.ny.gov
Corporation Name
o
Limited Liability Company (LLC)
Ø
Enclose a copy of the filing receipt issued by the NYS Department of State: (518) 473-2492 or www.dos.ny.gov
If you need assistance, call the Bureau of Driver Training Programs at 518-473-7174.
Forms are available at www.dmv.ny.gov/driveschool.htm
dmv.ny.gov
PAGE 1 OF 7
MV-521 (3/18)
DMV USE ONLY
DRIVING SCHOOL LICENSE APPLICATION
APPLICATION
LICENSE
No.
No.
Date Received
Fee Amount
Expiration Date
Fee Amount
PART 1
School Information:
l
READ VEHICLE AND TRAFFIC LAW SECTION 394 AND DMV COMMISSIONER’S REGULATIONS PART 76 BEFORE FILLING IN THIS FORM.
l
Print clearly or type.
Name of Driving School
Business Phone No. (Area Code)
Fax Number (Area Code)
(
)
(
)
Address of Main Office
Business Phone No. (Area Code)
Fax Number (Area Code)
Address of Branch Office
(
)
(
)
Contact Information - What is the name, phone number and email address of the individual we should send information to? If the
school has a website, please provide the website address. You must submit a Personal History (form MV-521.1) for this individual.
First
Last Name
Title
E-mail Address
Home Phone No. (Area Code)
Fax Number (Area Code)
Driving School Website Address
(
)
(
)
Application Fee Schedule
Please check the appropriate box below. See also “Additional Information” starting on page 6.
All fees are payable to
“The Commissioner of Motor Vehicles”
o
Original license application* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ 50.00
(non-refundable)
o
Branch license application*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No fee
o
Change of ownership*. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ 50.00
(non-refundable)
o
Add Partner(s) or Person(s) to business. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No fee
o
Change of address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No fee
o
Change of business name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No fee
o
Incorporating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No fee
* If your application for an original license or change of ownership is approved, you must pay a license fee of not more than $100 for a two­
year license. If your application for a branch license is approved, the fee is $1.50 per year. The fees are payable to “Commissioner of
Motor Vehicles”, in the form of a check (“starter checks” cannot be accepted) or money order.
PART 2
Check type of ownership (one ownership type per application) and include paperwork described below:
o
Individual with assumed name [sole proprietor or “doing business as” (DBA) name]
Ø
Enclose a copy of the certified business certificate certified by the County Clerk’s office.
o
Partnership with assumed name [“doing business as” (DBA) name]
Ø
Enclose a copy of the Certified Business Certificate for Partners certified by the County Clerk’s office. The partnership
papers must contain all partners’ names and the DBA name.
o
Corporation (Inc., Corp., Ltd.)
Ø
Enclose a copy of the filing receipt issued from the NYS Department of State: (518) 473-2492 or www.dos.ny.gov
Ø
If corporation is a DBA, you must also complete “Corporation with assumed name.”
o
Corporation with assumed name [“doing business as” (DBA) name]
Ø
Print corporation name below and enclose a copy of the Certificate of Assumed Name issued by the NYS Department
of State: (518) 473-2492 or www.dos.ny.gov
Corporation Name
o
Limited Liability Company (LLC)
Ø
Enclose a copy of the filing receipt issued by the NYS Department of State: (518) 473-2492 or www.dos.ny.gov
If you need assistance, call the Bureau of Driver Training Programs at 518-473-7174.
Forms are available at www.dmv.ny.gov/driveschool.htm
dmv.ny.gov
PAGE 1 OF 7
MV-521 (3/18)
Own (complete Section A)
{
DO YOU
PART 3
PLACE OF BUSINESS:
Lease (complete Sections A and B)
Sublease (complete Sections A, B and C)
Business Name
Business E-mail Address
Business Street Address (physical location)
Business Phone No. (Area Code)
(
)
City
State
ZIP
County
Name of Property Owner/Landlord
Phone No. (Area Code)
(
)
Owner Mailing Address (Include Number and Street)
City
State
ZIP
o
o
Number of Years or Months Owned?
Is this property zoned for the business type(s) you are applying for?
YES
NO
PLEASE NOTE: Whether you own or are leasing your business property, it is your responsibility to be in compliance with all state and local laws and regulations,
while being considered for a license and while conducting your business. You must provide a copy of the Certificate of Occupancy for all business locations. If
you do not provide this information with your application, the application will be denied.
B. If you are leasing, complete this section.
Phone No. (Area Code)
Print the Name the Lease is in (Lessee Name)
(
)
Business Address
City
State
ZIP
Expiration Date
/
/
C. If you are subleasing, complete this section and attach written approval from the landlord.
Print the Name the Sublease is in (Sublessee Name)
Phone No. (Area Code)
(
)
Expiration Date
City
State
ZIP
Business Address
/
/
PART 4
Ownership information (complete the section that applies):
A. INDIVIDUAL OWNERSHIP:
FEIN (Federal Employer Identification Number)
If owner is an out-of-state resident, attach government
issued ID or recent official copy of driver record.
Last Name
First
MI
Date of Birth (Month/Day/Year)
Residence Address (Include Number and Street)
City
State
ZIP
Residence Phone No. (Area Code)
(
)
Driver Identification Number
Social Security Number
Please Sign Name In Full
X
B. PARTNERSHIP:
Complete one section for each partner; if more than three, attach additional pages. If partner is an out-of-state resident, attach
government issued ID or recent official copy of driver record.
1.
Last Name
First
MI
Date of Birth (Month/Day/Year)
Residence Address (Include Number and Street)
City
State
ZIP
Residence Phone No. (Area Code)
(
)
Please Sign Name In Full
Driver Identification Number
Social Security Number
X
2.
Last Name
First
MI
Date of Birth (Month/Day/Year)
Residence Address (Include Number and Street)
City
State
ZIP
Residence Phone No. (Area Code)
(
)
Please Sign Name In Full
Driver Identification Number
Social Security Number
X
3.
Last Name
First
MI
Date of Birth (Month/Day/Year)
Residence Address (Include Number and Street)
City
State
ZIP
Residence Phone No. (Area Code)
(
)
Please Sign Name In Full
Driver Identification Number
Social Security Number
X
dmv.ny.gov
MV-521 (3/18)
PAGE 2 OF 7
NAME OF DRIVING SCHOOL:
C. CORPORATION or LIMITED LIABILITY COMPANY:
For Inc., Corp., LLC, or Ltd., list corporate officers (President, Secretary and Treasurer are
required). List stockholders and percentage of stock. For LLC, list all managing members. Attach additional pages if needed. Attach a copy of each listed
person’s driver license. (If any listed person is an out-of-state resident, attach copy of government issued ID or recent official copy of driver record.
1.
Last Name
First
MI
Date of Birth (Month/Day/Year)
Percentage of Stock
Title
Residence Address (Include Number and Street)
City
State
ZIP
Residence Phone No. (Area Code)
(
)
Please Sign Name In Full
Driver Identification Number
Social Security Number
X
2.
Last Name
First
MI
Date of Birth (Month/Day/Year)
Percentage of Stock
Title
Residence Address (Include Number and Street)
City
State
ZIP
Residence Phone No. (Area Code)
(
)
Please Sign Name In Full
Driver Identification Number
Social Security Number
X
3.
Last Name
First
MI
Date of Birth (Month/Day/Year)
Percentage of Stock
Title
Residence Address (Include Number and Street)
City
State
ZIP
Residence Phone No. (Area Code)
(
)
Please Sign Name In Full
Driver Identification Number
Social Security Number
X
Qualified Instructor – To be licensed, a driving school must employ at least one instructor who has a currently valid Driving
D.
School Instructor Certificate (form MV-524) and at least 1,000 hours of behind-the-wheel instruction. In the space below,
provide the information pertaining to this instructor; also attach proof of the 1,000 hours of instruction.
Last Name
First
MI
Instructor’s Certificate Number
Residence Address (Include Number and Street)
City
State
ZIP
Total No. of Hours Teaching
In-Car Instruction
Power of Attorney - Give the following information about all persons who have power of attorney for your driving school. Please
E.
include a copy of the Power of Attorney form with your application. If additional space is needed, attach additional page(s).
Last Name
First
MI
City
State
ZIP
Title
Residence Address (Include Number and Street)
Questions
F.
CHECK ONE
If you answer “Yes” to any question(s), please provide explanation and detail on page 4 or attach additional pages.
YES
NO
1. Have any of the owners, partners, corporate officers, managing members, managers or major stockholders ever
o
o
operated a driving school? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Have any of the owners, partners, corporate officers, managing members, managers or major stockholders ever been
o
o
convicted of a felony or crime involving violence, dishonesty, deceit, indecency, degeneracy or moral turpitude?....
3. Will you be offering the Prelicensing Course? If “Yes,” complete an Authorized Signature List (form MV-278.6)
o
o
and Request for Classroom Premises Check for Prelicensing Course (form MV-279) . . . . . . . . . . . . . . . . . . . . . .
4. Will your school offer Private Service Bureau services? If “YES”, attach a draft copy of your PSB receipt
o
o
showing all services and prices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
o
o
5. Does or will your school offer a Point Insurance Reduction Program (PIRP)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If “yes”, list the sponsor’s name and attach a list of all classroom locations used for PIRP classes:
o
o
o
o
o
6. What type(s) of vehicle(s) will you use for instruction?
Auto
Bus
Motorcycle
Tractor-Trailer
Truck
Services Offered - Attach a list of services you will provide and the prices for these services. You must include the fee and
G.
duration of each lesson.
dmv.ny.gov
MV-521 (3/18)
PAGE 3 OF 7
NAME OF DRIVING SCHOOL:
PART 5
Tell us about your business and associates:
A. Have you or any person named in this application ever had a financial interest in a DMV-regulated business that had its license,
registration or certification denied, suspended or revoked in New York State? This includes an interest as owner, partner, corporate
officer, managing member or stockholder holding more than twenty percent of the stock, and includes matters now on appeal.
o
o
NO
YES
If “YES”: Specify name and address of the person(s), business type, date and action taken against the business.
B. Are you, or is anyone named in this application, scheduled for a hearing that may result in the suspension, revocation
or denial of a DMV-issued business license or approval for a DMV-approved course (such as PIRP, Motorcycle Safety
o
o
Program Beginner Rider Course, PSB, etc.)?
NO
YES
If “YES”: Specify name and address of the person(s), business type, date and reason for hearing.
C. Have you or any person named in this application been convicted of, or forfeited bail for, any misdemeanor or felony at any
o
o
time?
NO
YES
If “YES”: Name
Date of Birth
Conviction Date
Penalty
Court
Attach copy of Certificate of Conviction, and explain nature of offense
(Further explanation may be attached.)
o
o
D. Does anyone else have a financial interest in your business that is not disclosed on this application?
No
Yes
If “YES”:
Name
o
o
E. Do you have any employees?
YES
NO
If “YES”: provide your Federal Employer Identification Number
, and attach a copy of proof of
Worker’s Compensation (form C-105.2 or U-26.3) and Disability Benefits Insurance (form DB-120.1) coverage from the NYS
Insurance Fund: www.nysif.com or (212) 312-9000
If “NO”: you can submit either proof of worker’s compensation and disability benefits (as above) or a Certification of
Attestation of Exemption (form CE-200) available at www.labor.ny.gov
PART 6
Attach additional pages if necessary
Additional Information (please identify the section name and/or question number related to the additional information you are providing).
dmv.ny.gov
PAGE 4 OF 7
MV-521 (3/18)
NAME OF DRIVING SCHOOL:
PART 7
Certification (all applicants must complete this section):
As a condition for the issuance and the continued validity of a driving school license, the individuals signing this
application agree to the following conditions:
to comply with all of the provisions of the New York State Vehicle and Traffic Law and the Commissioner’s Rules
u
and Regulations relating to driving schools and Private Service Bureaus.
to comply with all state laws and regulations, and all municipal ordinances and regulations relating to public
u
health and public safety for the school and business facility.
to employ (or otherwise make use of) only instructors who have been properly certified by the State of New York
u
to instruct at the applicant’s school.
The person(s) signing this application states that he or she is an owner, partner, officer, or managing member of the business named on this
application, and that all information provided in this application is true. To knowingly make a false statement in this application is a misdemeanor
punishable under Section 210.45 of the Penal code, and may result in the revocation of your driving school license. Making a false statement
in this application or in any proof or statements in writing in connection with it, or deceiving or substituting in connection with this
application is a misdemeanor under Section 392 of the Vehicle and Traffic Law, and may also result in the revocation or suspension of
your driving school license.
Signature of Owner or Corporate Officer or Managing Member
Title
Date
X
Signature of Owner or Corporate Officer or Managing Member
Title
Date
X
Signature of Owner or Corporate Officer or Managing Member
Title
Date
X
Signature of Owner or Corporate Officer or Managing Member
Title
Date
X
Signature of Owner or Corporate Officer or Managing Member
Title
Date
X
Signature of Owner or Corporate Officer or Managing Member
Title
Date
X
Application Prepared by
Print Name
Signature
Title
Date
NOTE: If you are applying for a license to open a driving school or a branch office, or to change your ownership or address, this
application package is the first part of a two-part process. After your application and supporting documents are received and
accepted (see page 2 of form MV-299.2), a Motor Vehicles License Examiner will visit your driving school/branch premises to
conduct an inspection.
You must meet all requirements to be approved.
Have you completed ALL SECTIONS that apply to your business?
l
Have you signed the application?
l
Have you included your check (NO STARTER CHECKS) or money order for the application fees, made payable to
l
“Commissioner of Motor Vehicles”?
Send this form and all papers required to complete your application package to:
NYS Department of Motor Vehicles
Bureau of Driver Training Programs
Certification & Oversight Unit
6 Empire State Plaza, Room 327
Albany NY 12228
(518) 473-7174
dmv.ny.gov
PAGE 5 OF 7
MV-521 (3/18)