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    MV 262

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    api-269134660

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    © All Rights Reserved
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    MV 262

    Uploaded by

    api-269134660
    213 views1 page

    Original Title

    mv262

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
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    213 views1 page

    MV 262

    Uploaded by

    api-269134660

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    New York State Department of Motor Vehicles

    CERTIFICATION OF SUPERVISED DRIVING


    Driver license applicants who have a junior learner permit (class DJ or MJ) must give this completed certificate to the Motor
    Vehicles License Examiner at the road test. Applicants must have driven at least 50 hours with supervision, which includes 15 hours
    after sunset. The number of hours driven with supervision in a certified Driver Education Course is considered part of the required 50
    hours and can be certified on the back of this form.
    Learner Permit
    Applicant Name ___________________________________________________________ID Number ________________________
    Address __________________________________________________________________________________________________
    __________________________________________________________________________________________________
    CERTIFICATION
    I certify that I am the parent or guardian of the applicant named above. I also certify that the applicant has completed at least 50
    hours of supervised driving, including 15 hours after sunset. I understand that some or all of the required supervised driving hours
    may have been completed with a licensed driving school instructor or driver education teacher, and that these hours may be certified
    on the reverse side of this form. I certify that any supervised driving hours that were not completed with a licensed driving school
    instructor or driver education teacher were completed: 1) under the immediate supervision of a person at least 21 years of age who
    holds a license that is valid in New York State to operate the type of vehicle that was used, and 2) in compliance with any regional
    restrictions applicable to driving with a junior learner permit in that area. I understand that falsifying any information on this
    certification may be a crime (felony or misdemeanor), punishable by a fine, imprisonment, or both.
    MV-262 (9/12)
    Printed Name of Parent or Guardian
    www.dmv.ny.gov
    Signature of Parent or Guardian Date

    NOTE TO THE PARENT OR GUARDIAN OF A JUNIOR DRIVER: You can remove the consent you gave when the junior driver
    described above submitted an application for a driver permit or driver license. To cancel the junior drivers class DJ or MJ permit or
    driver license, complete form MV-1W (Withdrawal of Consent) and submit the form to DMV.
    Name of School
    Driving
    School
    License
    Number
    Instructors Name
    Instructor
    Certificate
    Number
    Number
    of
    Hours
    Certified
    Administrator
    or Owner
    or Instructors
    Signature
    The number of hours driven while supervised by a driving school instructor or driver education teacher can be certified in the table
    below. All information provided in this table must be confirmed by records required according to the regulations of the Department of
    Motor Vehicles and the State Education Department. Any false statement is a violation of section 392 of the Vehicle and Traffic Law
    and is a misdemeanor.
    MV-262 (9/12)

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