Roster Sheet

							CODE: #18/                           INSTRUCTOR
LOCATION
DATE(S)                                                                      TOTAL # COMPLETED

40 IS THE MAXIMUM NUMBER OF STUDENTS PER CLASS AS REGULATED BY THE NYS DMV.
                FULL NAME                                      STUDENT’S SIGNATURE                             STUDENT'S SIGNATURE
               PLEASE PRINT                                          PART 1                                          PART 2
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          Under penalty of law, I attest to the fact that the motorists whose names and signatures appear on this class attendance roster have
          successfully completed the number of hours as required under Article 12-B of the New York State Vehicle and Traffic Law, and that
          any false information on this roster will be used as evidence in a court of law and/or administrative proceeding.
          INSTRUCTOR SIGNATURE:______________________________________________________________________