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Get NY DS-115 2012

New York State Department of Motor Vehicles REQUEST FOR NYS DRIVING PRIVILEGES To request clearance for New York State Driving Privileges please fill in the following information and include a non-refundable 25. 00 check/money order made payable to the Commissioner of Motor Vehicles. Full Last Name Full First Name Date of Birth mm/dd/yy Sex MI Daytime Phone Number Area Code - Optional / oM oF NYS Driver License Learner Permit or Non-Driver ID Card Number if available - CURRENT OUT-OF-STATE RESIDENCE ADDRESS Apt. Number Number and Street City or Town State Zip Code MAILING ADDRESS IF DIFFERENT THAN RESIDENCE Signature required Sign name in full Date Mail form and check/money order to NYS Department of Motor Vehicles 6 Empire State Plaza Albany NY 12228 Attention Driver Improvement Unit Room 336 Clear DS-115 8/12. New York State Department of Motor Vehicles REQUEST FOR NYS DRIVING PRIVILEGES To request clearance for New York State Driving Privileges please fill in the following information and include a non-refundable 25. 00 check/money order made payable to the Commissioner of Motor Vehicles. Full Last Name Full First Name Date of Birth mm/dd/yy Sex MI Daytime Phone Number Area Code - Optional / oM oF NYS Driver License Learner Permit or Non-Driver ID Card Number if available - CURRENT OUT-OF-STATE RESIDENCE ADDRESS Apt. New York State Department of Motor Vehicles REQUEST FOR NYS DRIVING PRIVILEGES To request clearance for New York State Driving Privileges please fill in the following information and include a non-refundable 25. 00 check/money order made payable to the Commissioner of Motor Vehicles. Full Last Name Full First Name Date of Birth mm/dd/yy Sex MI Daytime Phone Number Area Code - Optional / oM oF NYS Driver License Learner Permit or Non-Driver ID Card Number if available - CURRENT OUT-OF-STATE RESIDENCE ADDRESS Apt. .

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