CERTIFICATION OF RESIDENCE

This Certification of Residence can be used to provide proof of principal residence address and should be completed by
the individual making the certification and the applicant for which the certification applies. This form must accompany
one additional proof of principal residence in the applicant’s name. A list of acceptable residence proofs can be found on
form ID-44. This form is not acceptable for proof of residency for a standard document.

Relationship of individual making certification includes:

• Co-resident
• Employer
• Landlord
• Neighbor
• Parent or Legal Guardian
• School Official
• Spouse
t CERTIFICATION
I, , as the
(Full Name) (Relationship of Individual Making Certification)

certify , currently resides at

(Full Name of Applicant)

(Address)

and that this is the applicant’s full name and that (s)he resides at the address above. I state that the information I have
given in this certification is true to the best of my knowledge. I understand that any false statement I have made on
this certification may be punishable as a criminal offense.

Individual Making Certification (Print Name Here):

Signature of Individual Making Certification ç

Applicant (Print Name Here):

Signature of Applicant ç

MAKING ANY FALSE STATEMENT ON THIS CERTIFICATION OF RESIDENCE IS PUNISHABLE BY LAW.

FOR OFFICE USE

Signature of DMV Employee Accepting Proof ç

MV-44NYR (12/19)