New York State Department of Motor Vehicles INDIVIDUAL’S REQUEST FOR NATIONAL DRIVER REGISTER FILE SEARCH The National Driver Register (NDR) is a list of drivers whose driver licenses have been suspended, revoked, denied or withdrawn, or who have been convicted of certain serious traffic violations. Any person may ask if there is information about him/her on the NDR files, whether this information has been disclosed to anyone, and to whom it was disclosed. You will not be listed in the NDR if you have not had a driver license cancelled, denied, revoked or suspended, or have not been convicted of a serious traffic violation. NDR search results will be mailed directly to you at the address provided on this form. The NDR will not process your request: if the information provided on this form is incomplete or cannot be read; or if the form is not signed in the presence of a Motor Vehicles representative or is not notarized. The NDR will respond to every processed request, including those where no record is found on file. If a record is found, the full record will be copied and sent directly to you, including any older records that may have contained a reason for the license cancellation, denial, revocation or suspension. Also, if the NDR information has been released to anyone, the report will identify who received it. The name and address of the licensing authority in each state that reported the information will be provided in the report in case you want to ask for more detailed information about the action reported, or if you need to correct an error. Obtaining specific information about your record, or correcting errors, can only be done by contacting the state(s) that provided the information to the NDR. INSTRUCTIONS: N N N Type or clearly print all information requested. The person whose record is being checked must authorize the NDR search by signing this form in the presence of a Motor Vehicles representative, and must present proof of identity (see form ID-44 for acceptable proofs of identity). You may pre-sign the form, providing your signature is notarized. You may send this form directly to the NDR at the following address: National Driver Register Nassif Building 400 - 7th Street, S.W. Washington DC 20590 OR you may ask a Motor Vehicles office to send your request to the NDR for you. A $10 fee is charged to do this, payable by cash, or by check or money order made payable to the Commissioner of Motor Vehicles. Last Name First M.I. Previous Last Name or Maiden Name Date of Birth (Mo./Day/Year) Sex / / M Height Eye Color F Apt. No. Address Where You Get Your Mail (Include Street Number and Name, Rural Delivery and/or Box Number) City or Town State Driver License Number SIGN HERE Zip Code State Where License was Issued Social Security Number (Optional) ± __________________________________________________________________ Date ____________________________ (Sign Name in Full) FOR OFFICE USE ONLY - NOT TO BE COMPLETED BY CUSTOMER Proof Submitted Other: Birth Certificate Driver License/ID Credit Card Passport Learner Permit INS Papers NOTARIZATION — Required only if this form is not signed in the presence of a Motor Vehicles representative. Sworn to and ascribed before me this______________ day Approved By (Print Name) Office Notary Public Seal or Stamp of________________ in the year of __________ in the city/ SIGNATURE ± Date county of__________________ State of___________________ www.nysdmv.com NDR-1 (10/07) American LegalNet, Inc. www.FormsWorkFlow.com