STATE OF ALASKA
DIVISION OF MOTOR VEHICLES
REQUEST FOR DRIVING RECORD
There is a $10 fee for each driving record. PRINT CLEARLY.
Submit request to DMV Research:
SELECT RECORD TYPE:
1300 W. Benson Blvd., Suite 410
Anchorage, AK 99503
Insurance Record (no CDL medical cert.)
Phone: 907-269-3754
Fax: 907-269-5202
Full Record Non-CDL (no CDL medical cert.)
Email: doa.dmv.research@alaska.gov
Record for CDL Employment / CDL Holder (includes CDL medical cert.)
If you have a CDL, only a Record for CDL Employment / CDL Holder can be provided per 2 AAC 90.470(d)
REQUESTOR INFORMATION
Requestor Name
Phone Number
Alaska Driver License Number
Date of Birth
Social Security Number
OR
AND
RELEASE TO ANOTHER PERSON OR COMPANY (OPTIONAL)
By initialing this box I authorize the DMV to release my driving record to the person or company listed below:
Printed Name
Contact Phone Number
337-376-5242
Compliance Background Screening Services
I WANT MY RECORD TO BE SENT VIA:
Email
Fax
Mail
Email Address
Fax Number
800-403-9044
Mailing Address
P.O. Box 52911, Lafayette, LA 70505
Signature of Requestor
Date(Valid for 90 days)
PAYMENT INFORMATION
Make check or money order payable to DMV or State of Alaska. DO NOT MAIL CASH.
MasterCard or Visa #
Expiration Date
Name as shown on card
Security Code (3 digit code on back of card)
I understand that my credit card will be charged $10 for each driving record.
Signature of credit card holder
Date
(Valid for 90 days)
DMV USE ONLY
BATCH
AMVC ID / OFFICE
I have verified ID for in-person request.
$10
Expiration Date:
FEE:
CA
CC
CK
Form 419F Rev. 12/2014