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Temporary Photo Document
Temporary Photo Document
10/22/18
NONE
NONE
NYS Department of Motor Vehicles
Changing Address?
If you change your residence, cross out the old address on the front
Restrictions B
of this document and write in your new address. You must notify
This document expires on
Additional Restrictions
DMV of your new address within 10 days, using DMV Form MV-
NY
Status terminates on
07/20/52
www.dmv.ny.gov.
4363 DEREIMER AVE
INTERIM LICENSE
Restrictions
Probation Date
Birthdate
Sex F
C MECHANICAL AID
X NO CARGO IN CMV TANK VEH
Here
Sign
D PROSTHETIC DEVICE
E NO MAN TRANS EQUIPPED CMV X1 FULL HAND CONTROL
E1 AUTOMATIC TRANSMISSION Y SHOULDER HARNESS USE (FOLD ALONG THIS LINE)
Z NO FULL AIRBRAKE EQUIP CMV
AUG 23 2018
F OUTSIDE MIRROR
THIS TEMPORARY DOCUMENT IS NOT VALID
CDA
T DOUBLES/TRIPLES
I8172995
209590
OR MORE ADULT PASSENGERS X TANK/HAZMAT
O NO TRACTOR/TRAILER CMV
O1 NO TRACTOR TRAILER CMV/
TRUCK NOT OVER 26,000 GVWR
07/20/52
DOB
AUG 23 2018 WEB
WHITTAKER
I8172995
209590
DIANE