New York State Department of Motor Vehicles STATEMENT OF IDENTITY For Applicants who can be considered a disenfranchised, homeless youth This document is used for Identity Only and cannot be used for Proof of Date of Birth. Proof of Date of Birth and a Social Security card are required. This document cannot be used as proof to obtain a Commercial Driver License (CDL), or an Enhanced Driver License (EDL) or Enhanced Non-Driver Photo ID Card (ENDID) This statement may only be used by an applicant who can be considered a disenfranchised, homeless youth, is represented by a Government or Government-Approved facility, AND who cannot provide sufficient proof of identity from the proofs listed on form ID-44 (Proofs of Identity). The applicant and his or her approved facility representative may use the following method to provide acceptable PROOF OF NAME/ IDENTITY: w The applicant must present an Original Social Security card and Proof of Date of Birth. w The approved representative must accompany the applicant when he or she applies for a permit/ID card and must sign this form in the presence of a Motor Vehicle Representative. w The applicant’s representative must be a government or government-approved facility representative, and must provide a letter on the facility’s letterhead, signed by the facility’s director which verifies the applicant's name, date of birth, height, eye color, address, the name of the facility and the name of the representative. w The representative must also present his/her original NYS issued Photo Document or provide documents which meet the identification requirements as listed on form ID-44, along with the above documents at the time of application. CERTIFICATION I, ___________________________________________________________________________________, certify as the Representative (Name of Representative) of ____________________________________________________________________________________________________________, (Name of Applicant) that (s)he is currently without a permanent place of residence, that this name is the name by which (s)he is commonly known and that (s)he receives mail at the Facility’s Mailing Address listed below. To the best of my knowledge, (s)he has not obtained or applied for a learner permit, non-driver identification card or driver license in any other name. I understand that any false statement I have made on this certification is a misdemeanor under Section 392 of the Vehicle & Traffic Law. This certification must be accompanied by an original letter from the government facility that has approved the applicant’s representative (see above). IMPORTANT: DO NOT SIGN THIS FORM UNTIL YOU ARE WITH A MOTOR VEHICLE REPRESENTATIVE. APPLICANT’S REPRESENTATIVE Sign Here ç __________________________________________________________________ Print Your Name: ______________________________________________________________________________________________ Identification No. from your Driver License, Permit or Non-Driver ID Card: ________________________________________________ Print Your Facility’s Name:__________________________________________________Facility’s Phone No.: ____________________ Facility’s Mailing Address: ______________________________________________________________________________________ IMPORTANT: DO NOT SIGN THIS FORM UNTIL YOU ARE WITH A MOTOR VEHICLE REPRESENTATIVE. APPLICANT Sign Here ç _______________________________________________________________________________ OFFICE USE ONLY o NYS Photo Driver License/Permit/Non-Driver ID o Social Security Card o Original Facility Letter o Proof of DOB:___________ o Proof of ID: _______________________________________ Signature of Person Accepting Proof ç ____________________________________________________________________ Proofs of Identify Presented by Representative: Title of Person Accepting Proof: ________________________________________________ Office: _______________________________________________________________ Date ____________________________________ MV-45B (4/11) www.dmv.ny.gov American LegalNet, Inc. www.FormsWorkFlow.com