New York State Department of Motor Vehicles EXEMPT VEHICLE CERTIFICATE INSTRUCTIONS N An ambulance is exempt from an annual registration fee if no charge is made for services, or if the cost of service is incidental to the operation of a non-profit hospital. N You must provide a New York State Insurance Identification Card (Form FS-20) to register an ambulance or bus if “For-Hire” insurance coverage is not required. You can obtain the required insurance coverage and identification card from any insurance company authorized to do business in New York State N This certificate must be signed. If the vehicle is registered by a firm or corporation, an officer must sign this certificate. Specify the officer’s title or position in the box at the bottom of this form. I, ______________________________________________________, affirm under penalty of perjury that the information given below is correct, and that I am the owner of this vehicle, or an officer of the firm or corporation registering this vehicle. This certificate pertains to the vehicle with license plate number_________________________________. Note: If the vehicle is not currently registered by you (and does not have a license plate on it), please provide the vehicle identification number: _________________________________________________________________________________. Check the box that applies to this vehicle: This vehicle is an ambulance and no charge is made for services, or the cost of service is incidental to the operation of a non-profit hospital. This vehicle is a bus and no charge, direct or indirect, is made for carrying any person. The vehicle has a seating capacity of _____________ and is used follows:________________________________________ Signature (See “Instructions” above) ±_____________________________________________________________ Name of Registrant (Print or Type) Street Address City Apt. # State Zip Code Title or position (if a firm or corporation) MV-197 (11/07) www.nysdmv.com American LegalNet, Inc. www.FormsWorkFlow.com