Certification Of Supervised Driving {MV-262}

CERTIFICATION OF SUPERVISED DRIVING dmv.ny.gov Driver license applicants who have a junior learner permit (class DJ or MJ) must give this completed certificate to the Motor Vehicle License Examiner at every 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 __________________________________________________________________________________________________ __________________________________________________________________________________________________ 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 driver's class DJ or MJ permit or driver license, complete form MV-1W (Withdrawal of Consent) and submit the form to DMV. 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 below. 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. Printed Name of Parent or Guardian Signature of Parent or Guardian MV-262 (11/16) ç Date 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. Driving School License Number Number of Hours Certified Administrator or Owner or Instructor's Signature Name of School Instructor's Name Instructor Certificate Number MV-262 (11/16) American LegalNet, Inc. www.FormsWorkFlow.com