Application Fee Schedule Please check the appropriate box below. See also Additional Information starting on page 6.

Transcription

1 DRIVING SCHOOL LICENSE APPLICATION N. APPLICATION DMV USE ONLY N. LICENSE Received Fee Amunt Expiratin Fee Amunt PART 1 Schl Infrmatin: l READ VEHICLE AND TRAFFIC LAW SECTION 394 AND DMV COMMISSIONER S REGULATIONS PART 76 BEFORE FILLING IN THIS FORM. l Print clearly r type. Name f Driving Schl Address f Main Office Business Phne N. (Area Cde) Fax Number (Area Cde) Address f Branch Office Business Phne N. (Area Cde) First Fax Number (Area Cde) Cntact Infrmatin - What is the name, phne number and address f the individual we shuld send infrmatin t? If the schl has a website, please prvide the website address. Yu must submit a Persnal Histry (frm MV-521.1) fr this individual. Address Driving Schl Website Address Hme Phne N. (Area Cde) Fax Number (Area Cde) Applicatin Fee Schedule Please check the apprpriate bx belw. See als Additinal Infrmatin starting n page 6. All fees are payable t The Cmmissiner f Mtr Vehicles Original license applicatin* $ (nn-refundable) Branch license applicatin* N fee Change f wnership* $ (nn-refundable) Add Partner(s) r Persn(s) t business N fee Change f address N fee Change f business name N fee Incrprating N fee * If yur applicatin fr an riginal license r change f wnership is apprved, yu must pay a license fee f nt mre than $100 fr a twyear license. If yur applicatin fr a branch license is apprved, the fee is $1.50 per year. The fees are payable t Cmmissiner f Mtr Vehicles, in the frm f a check ( starter checks cannt be accepted) r mney rder. PART 2 Check type f wnership (ne wnership type per applicatin) and include paperwrk described belw: Individual with assumed name [sle prprietr r ding business as (DBA) name] Ø Enclse a cpy f the certified business certificate certified by the Cunty Clerk s ffice. Partnership with assumed name [ ding business as (DBA) name] Ø Enclse a cpy f the Certified Business Certificate fr Partners certified by the Cunty Clerk s ffice. The partnership papers must cntain all partners names and the DBA name. Crpratin (Inc., Crp., Ltd.) Ø Enclse a cpy f the filing receipt issued frm the NYS Department f State: (518) r Ø If crpratin is a DBA, yu must als cmplete Crpratin with assumed name. Crpratin with assumed name [ ding business as (DBA) name] Ø Print crpratin name belw and enclse a cpy f the Certificate f Assumed Name issued by the NYS Department f State: (518) r Crpratin Name Limited Liability Cmpany (LLC) Ø Enclse a cpy f the filing receipt issued by the NYS Department f State: (518) r If yu need assistance, call the Bureau f Driver Training Prgrams at Frms are available at PAGE 1 OF 7

2 PART 3 Business Name PLACE OF BUSINESS: DO YOU { Own (cmplete Sectin A) Lease (cmplete Sectins A and B) Sublease (cmplete Sectins A, B and C) Print name and lcatin f business, and business address, belw: Business Address Business Street Address (physical lcatin) City State ZIP Business Phne N. (Area Cde) Cunty A. All applicants must cmplete this sectin. Name f Prperty Owner/Landlrd Owner Mailing Address (Include Number and Street) Phne N. (Area Cde) City State ZIP Number f Years r Mnths Owned? Is this prperty zned fr the business type(s) yu are applying fr? YES NO PLEASE NOTE: Whether yu wn r are leasing yur business prperty, it is yur respnsibility t be in cmpliance with all state and lcal laws and regulatins, while being cnsidered fr a license and while cnducting yur business. Yu must prvide a cpy f the Certificate f Occupancy fr all business lcatins. If yu d nt prvide this infrmatin with yur applicatin, the applicatin will be denied. B. If yu are leasing, cmplete this sectin. Print the Name the Lease is in (Lessee Name) Phne N. (Area Cde) Business Address Expiratin / / C. If yu are subleasing, cmplete this sectin and attach written apprval frm the landlrd. Print the Name the Sublease is in (Sublessee Name) Phne N. (Area Cde) Business Address Expiratin / / PART 4 Ownership infrmatin (cmplete the sectin that applies): A. INDIVIDUAL OWNERSHIP: If wner is an ut-f-state resident, attach gvernment FEIN (Federal Emplyer Identificatin Number) issued ID r recent fficial cpy f driver recrd. B. PARTNERSHIP: Cmplete ne sectin fr each partner; if mre than three, attach additinal pages. If partner is an ut-f-state resident, attach gvernment issued ID r recent fficial cpy f driver recrd PAGE 2 OF 7

3 C. CORPORATION r LIMITED LIABILITY COMPANY: Fr Inc., Crp., LLC, r Ltd., list crprate fficers (President, Secretary and Treasurer are required). List stckhlders and percentage f stck. Fr LLC, list all managing members. Attach additinal pages if needed. Attach a cpy f each listed persn s driver license. (If any listed persn is an ut-f-state resident, attach cpy f gvernment issued ID r recent fficial cpy f driver recrd. 1. Percentage f Stck 2. Percentage f Stck 3. Percentage f Stck D. Qualified Instructr T be licensed, a driving schl must emply at least ne instructr wh has a currently valid Driving Schl Instructr Certificate (frm MV-524) and at least 1,000 hurs f behind-the-wheel instructin. In the space belw, prvide the infrmatin pertaining t this instructr; als attach prf f the 1,000 hurs f instructin. First MI Instructr s Certificate Number Ttal N. f Hurs Teaching In-Car Instructin E. Pwer f Attrney - Give the fllwing infrmatin abut all persns wh have pwer f attrney fr yur driving schl. Please include a cpy f the Pwer f Attrney frm with yur applicatin. If additinal space is needed, attach additinal page(s). First MI F. Questins CHECK ONE If yu answer Yes t any questin(s), please prvide explanatin and detail n page 4 r attach additinal pages. YES 1. Have any f the wners, partners, crprate fficers, managing members, managers r majr stckhlders ever perated a driving schl? NO 2. Have any f the wners, partners, crprate fficers, managing members, managers r majr stckhlders ever been cnvicted f a felny r crime invlving vilence, dishnesty, deceit, indecency, degeneracy r mral turpitude? Will yu be ffering the Prelicensing Curse? If Yes, cmplete an Authrized Signature List (frm MV-278.6) and Request fr Classrm Premises Check fr Prelicensing Curse (frm MV-279) Will yur schl ffer Private Service Bureau services? If YES, attach a draft cpy f yur PSB receipt shwing all services and prices Des r will yur schl ffer a Pint Insurance Reductin Prgram (PIRP)? If yes, list the spnsr s name and attach a list f all classrm lcatins used fr PIRP classes: 6. What type(s) f vehicle(s) will yu use fr instructin? Aut Bus Mtrcycle Tractr-Trailer Truck G. Services Offered - Attach a list f services yu will prvide and the prices fr these services. Yu must include the fee and duratin f each lessn. PAGE 3 OF 7

4 PART 5 Tell us abut yur business and assciates: A. Have yu r any persn named in this applicatin ever had a financial interest in a DMV-regulated business that had its license, registratin r certificatin denied, suspended r revked in New Yrk State? This includes an interest as wner, partner, crprate fficer, managing member r stckhlder hlding mre than twenty percent f the stck, and includes matters nw n appeal. NO YES If YES : Specify name and address f the persn(s), business type, date and actin taken against the business. B. Are yu, r is anyne named in this applicatin, scheduled fr a hearing that may result in the suspensin, revcatin r denial f a DMV-issued business license r apprval fr a DMV-apprved curse (such as PIRP, Mtrcycle Safety Prgram Beginner Rider Curse, PSB, etc.)? NO YES If YES : Specify name and address f the persn(s), business type, date and reasn fr hearing. C. Have yu r any persn named in this applicatin been cnvicted f, r frfeited bail fr, any misdemeanr r felny at any time? NO YES If YES : Name f Birth Cnvictin Penalty Curt Attach cpy f Certificate f Cnvictin, and explain nature f ffense (Further explanatin may be attached.) D. Des anyne else have a financial interest in yur business that is nt disclsed n this applicatin? N Yes If YES : Name E. D yu have any emplyees? YES NO If YES : prvide yur Federal Emplyer Identificatin Number, and attach a cpy f prf f Wrker s Cmpensatin (frm C r U-26.3) and Disability Benefits Insurance (frm DB-120.1) cverage frm the NYS Insurance Fund: r (212) If NO : yu can submit either prf f wrker s cmpensatin and disability benefits (as abve) r a Certificatin f Attestatin f Exemptin (frm CE-200) available at PART 6 Attach additinal pages if necessary Additinal Infrmatin (please identify the sectin name and/r questin number related t the additinal infrmatin yu are prviding). PAGE 4 OF 7

5 PART 7 Certificatin (all applicants must cmplete this sectin): As a cnditin fr the issuance and the cntinued validity f a driving schl license, the individuals signing this applicatin agree t the fllwing cnditins: u t cmply with all f the prvisins f the New Yrk State Vehicle and Traffic Law and the Cmmissiner s Rules and Regulatins relating t driving schls and Private Service Bureaus. u u t cmply with all state laws and regulatins, and all municipal rdinances and regulatins relating t public health and public safety fr the schl and business facility. t emply (r therwise make use f) nly instructrs wh have been prperly certified by the State f New Yrk t instruct at the applicant s schl. The persn(s) signing this applicatin states that he r she is an wner, partner, fficer, r managing member f the business named n this applicatin, and that all infrmatin prvided in this applicatin is true. T knwingly make a false statement in this applicatin is a misdemeanr punishable under Sectin f the Penal cde, and may result in the revcatin f yur driving schl license. Making a false statement in this applicatin r in any prf r statements in writing in cnnectin with it, r deceiving r substituting in cnnectin with this applicatin is a misdemeanr under Sectin 392 f the Vehicle and Traffic Law, and may als result in the revcatin r suspensin f yur driving schl license. Applicatin Prepared by Print Name Signature NOTE: If yu are applying fr a license t pen a driving schl r a branch ffice, r t change yur wnership r address, this applicatin package is the first part f a tw-part prcess. After yur applicatin and supprting dcuments are received and accepted (see page 2 f frm MV-299.2), a Mtr Vehicles License Examiner will visit yur driving schl/branch premises t cnduct an inspectin. Yu must meet all requirements t be apprved. l Have yu cmpleted ALL SECTIONS that apply t yur business? l Have yu signed the applicatin? l Have yu included yur check (NO STARTER CHECKS) r mney rder fr the applicatin fees, made payable t Cmmissiner f Mtr Vehicles? Send this frm and all papers required t cmplete yur applicatin package t: NYS Department f Mtr Vehicles Bureau f Driver Training Prgrams Certificatin & Oversight Unit 6 Empire State Plaza Albany NY (518) PAGE 5 OF 7

6 ADDITIONAL INFORMATION: PART 1 Nn-refundable applicatin fee: Only applicatins fr an ORIGINAL r CHANGE OF OWNERSHIP require an applicatin fee. The fee is fifty dllars ($50) and must be paid in the frm f a check (n starter checks can be accepted) r mney rder, made payable t Cmmissiner f Mtr Vehicles. PART 4 Ownership infrmatin Tell us yur business structure (hw yu set up the business t perate yur drivers schl). The dcumentatin yu include with yur applicatin will depend n yur business structure. See the list belw fr the dcumentatin yu must include with yur applicatin: Sle Prprietr: Certified cpy f the Business Certificate by the Cunty Clerk s Office Partnership: Certified cpy f the Business Certificate fr Partners by the Cunty Clerk s Office Crpratin: Certified cpy f the Certificate f Incrpratin Filing Receipt (issued by Department f State) If the crpratin is a dba with anther name, then the applicant must als submit the certificate f assumed name (issued by Department f State). Schl Infrmatin Minutes f the crpratin meeting that identify: When the meeting was held Wh was in attendance l Minutes must be signed by all fficials f the crpratin and l Minutes must be ntarized OR have a crprate seal The purpse f the frmatin f the crpratin (t cnduct the business f the driver s schl in accrdance with VTL 394) Lcatin f the place f business Crprate fficers (CEO, President, VP, Secretary, Treasurer, Crprate Officers) Distributin f shares (including ttal number f shares) f the crpratin and t whm they are distributed. NOTE: All shares d nt have t be distributed, but at least ne fficer must wn a minimum f 20% f the ttal shares distributed. l Persn wh is respnsible fr the peratin must have at least 20% f the shares l NOTE: The filing receipt identifies the number f shares. L.L.C. (Limited Liability Cmpany): Certified cpy f the Certificate f Incrpratin (issued by Department f State) Minutes f the cmpany meeting that identify: When the meeting was held Wh was in attendance (i.e. the members) l Minutes must be signed by all members f the cmpany and l Minutes must be ntarized OR have crprate seal The purpse f the frmatin f the cmpany t cnduct the business f the driver s schl in accrdance with VTL 394 Lcatin f the place f business Members f the L.L.C., and their respective titles PART 5 Tell us abut yur business and assciates Emplyee Benefits Cverage: Yu must shw prf that yu have either: Wrker s Cmpensatin (frm C r U-26.3) and Disability Benefits Insurance (frm DB-120.1) OR Certificate f Attestatin f Exemptin frm NYS Wrk s Cmpensatin and/r Disability Benefits Cverage (frm CE-200), fund at Persnal Histry (frm MV-521.1): Yu must prvide this fr all staff except instructrs. Required Instructr Verificatin: Yu must have at least ne certified instructr. Frm MV-523 Applicatin fr Driving Schl Instructr Certificate (and all supprting dcuments and fees). At least ne instructr must have a minimum f 1,000 hurs behind-the-wheel teaching experience. A ntarized statement is required t verify this experience. If a ntarized statement is nt available, we ll review any persnal statement with supprting dcumentatin. PAGE 6 OF 7

7 PART 6 Place f Business Prf f lcatin fr business: Yur driving schl must have a physical ffice (which DMV will inspect befre a license is issued). As part f the applicatin, yu must include prf f yur ffice lcatin by including a cpy f a deed r lease r sublease. Yu must als include a cpy f the certificate f ccupancy. NOTE: if this is a sub-lease, yu must submit a cpy f the rental lease issued t the tenant and a written statement frm the landlrd, which acknwledges the apprval f the presence f a driving schl at the lcatin. General Infrmatin Required Driving Schl Recrds. A driving schl is required t keep recrds f business and custmers. With yur applicatin yu must submit a draft cpy f: Student Recrd Card Business Receipt and/r Cntract(s) the schl will use - ptinal Private Service Bureau (PSB) receipt if the business intends t perate a PSB - ptinal List f Driving Schl Vehicles (frm MV-527). All vehicles used fr training r rad testing must be reprted. Even if the schl has n vehicles, the MV-527 is required and must indicate n vehicles. Prelicensing Curse (ptinal): A driving schl which prvides the DMV Prelicensing Curse must have an apprved classrm and qualified classrm-endrsed instructr. Include Premises Check (frm MV-279) and Prf f Lcatin f classrm (if at a different lcatin), cnsisting f a deed r lease r sublease NOTE: if this is a sub-lease, yu must submit a cpy f the rental lease issued t the tenant and a written statement frm the landlrd, which acknwledges the apprval f the presence f a driving schl at the lcatin. Authrized Signature List (frm MV-278.6) Applicatin fr Access t DMV Internet Rad Test Scheduling System (frm MV-522.1) (ptinal). All driver license testing with DMV is scheduled using an autmated scheduling system. Driving schls can apply fr an accunt that allws them t schedule appintments fr their custmers. MV-521 (9/15) PAGE 7 OF 7