Driving Records Release Form
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1
2DRIVER SERVICES
STATE OF ARKANSAS
Driving Records
Department of Finance
Ragland Building, Room 1130
Post Office Box 1272
And Administration
Little Rock, Arkansas 72203
Phone: (501) 682-7207
Fax: (501) 682-2075
ARKANSAS DRIVING RECORDS RELEASE FORM
I, ____________________________________________________DO HEREBY AUTHORIZE
OFFICE OF DRIVER SERVICES TO RELEASE MY:
INSURANCE RECORD - $7.00
COMMERCIAL RECORD - $10.00
TO: __________________________________________________________________________
(NAME)
______________________________________________________________________________
(ADDRESS)
______________________________________________________________________________
(CITY, STATE, ZIP)
THIS RELEASE SHALL REMAIN IN FULL FORCE AND EFFECT FOR THE NEXT FIVE (5)
YEARS, UNLESS A FORMAL WITHDRAWAL IS FILED BY ME.
SIGNATURE___________________________________________________________
DATE OF BIRTH________________________________________________________
ARKANSAS DRIVERS LICENSE #_________________________________________
CURRENT DATE____________________________
THIS FORM MUST BE FILLED OUT IN FULL FOR RECORDS TO BE PROCESSED.
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Parent category: Financial