Form 851 - Request For Research Or Verification Of Motor Vehicle Record printable pdf download

STATE OF ALASKA

DIVISION OF MOTOR VEHICLES

REQUEST FOR RESEARCH OR VERIFICATION OF MOTOR VEHICLE RECORD

INSTRUCTIONS: PLEASE PRINT OR TYPE CLEARLY. You may only obtain the information if you certify you are authorized to receive the information

for one of the reasons outlined under TYPE OF RESEARCH NEEDED below. Personal information contained in vehicle records is confidential under

federal and state law. You must submit a separate form and $10 for each vehicle research request.

REQUESTOR INFORMATION

Requestor Name

Business Name

Alaska Driver’s License Number

Date of Birth*

Last 4 Digits of Social Security Number*

Contact Phone Number

* Required if requestor does not have an Alaska driver’s license. Information will be used solely

to verify requestor identity.

PAYMENT INFORMATION

Select Payment Type:

Visa

MasterCard

Check (included with mailed request) Do not mail cash

Credit Card Number:

Expiration:

Security Code (3 digit code on back of card):

Name as it appears on the card:

I understand that my credit card shown above will be charged $10 for each vehicle record.

Cardholder Signature

Date (Valid for 90 days)

Mail

I WANT THE VEHICLE RECORD TO BE SENT VIA:

Fax

Email Address:

Fax Number:

Mailing Address:

VEHICLE INFORMATION

Alaska License Plate Number

Vehicle or Hull Identification Number

Owner Name(s)

Year

Make

Model

Body Style

Color

TYPE OF RESEARCH NEEDED

Submit request to DMV Research:

Copy of source document used to originally title or register the vehicle in Alaska.

(i.e. title from previous state, Manufacturer’s Certificate of Origin, etc.)

1300 W. Benson Blvd., Suite 410

Computer printout of current motor vehicle registration information.

Anchorage, AK 99503

Owner and lienholder’s name and address.

Phone: 907-269-3754

Fax: 907-269-5202

Copy of a prior DMV transaction.

Email: doa.dmv.research@alaska.gov

(i.e. registration application, documents submitted to obtain a title)

Other (please be specific):

I certify that I am authorized to receive the motor vehicle record information for the reason checked below:

I am the owner of record of this vehicle.

I have the written permission of the owner(s) and lienholder (if lienholder is an individual) of record of this vehicle and have attached owner

and lienholder’s permissions.

I am an agent, employee, or contractor of a legitimate business, and am requesting verification of information provided to the business by

the owner of the vehicle. This information will be used only for the purpose of preventing fraud by pursuing legal remedies against or

recovering on a debt or security interest against the owner of the vehicle. Requestor must attach a copy of the information provided to the

business by the vehicle owner.

DMV Use Only:

Information correct

Edited incorrect personal information

Verified by _

____/____/20___

The requested information is to be used in connection with a civil, criminal, administrative or arbitration proceeding in a court or

government agency or before a self-regulatory body.

I am an agent, employee or contractor for an insurer or an insurance support agency and the information will be used in connection with

claims investigation activities, anti-fraud activities, rating, or underwriting.

The information will be used to provide notice to owners of a towed, impounded, or abandoned vehicle.

I certify under penalty of law that I am authorized as an individual or as an employee, agent, or contractor of a business to receive motor vehicle record

information as provided in AS 28.10.505 for the reason checked above. I further certify that this information will not be sold or disclosed except as

provided by law. I have personally reviewed the information on this application and certify under penalty of perjury that to the best of my knowledge and

belief the information on this application is true and correct. (NOTE: Making a false statement or omitting a material fact is subject to a maximum penalty

of $10,000 or 1 year imprisonment or both per AS 11.56.210 and AS 28.35.135.)

Signature

Date

(Valid for 90 days from this date.)

Alaska.gov/dmv

Form 851 (Rev. 10/2014)