Dmv Request For Records - Reilly Newman
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1
2REQUEST FOR RECORD INFORMATION
Instructions (Inst.)
PART I: Record Request
A Public Service Agency
APPLICABLE FEE MUST ACCOMPANY REQUEST
Certify the record as a true copy of record on file with Department of Motor Vehicles - No Charge
TYPE OF INFORMATION REQUESTED (CHECK ONLY ONE BOX PER REQUEST)
Driver License/Identification Card (DO NOT COMPLETE SECTION C)
Vehicle/Vessel (DO NOT COMPLETE SECTION B)
Inst.
SECTION A – Requester’s Information – ALL INFORMATION REQUIRED
REQUESTER’S NAME (FIRST, MI, LAST)
DAYTIME TELEPHONE NUMBER
(
)
ADDRESS
CITY
STATE
ZIP CODE
Inst.
–
SECTION B – DL/ID Record Request ONLY
NAME AND DL/ID # OR NAME AND DATE OF BIRTH REQUIRED
INDIVIDUAL NAME (FIRST, MI, LAST)
AND
DRIVER LICENSE/IDENTIFICATION CARD NUMBER
OR
DATE OF BIRTH (MM/DD/YYYY)
Automated record (computer printout) - FEE: $5 Per Record
Photocopy of hardcopy and/or microfilm documents - FEE: $20 Per Copy
Current Record
DL/ID Photo
DL/ID Application (Guarantor’s Signature Search)
Other (Explain)
Other (Explain)
Inst.
–
SECTION C – VR/VESSEL Record Request ONLY
COMPLETE LINE
OR
C1
C2
CA LICENSE PLATE/CF NUMBER
OR
VEHICLE/HULL IDENTIFICATION NUMBER
MAKE (Optional)
YEAR MODEL (Optional)
C1
Automated record (computer printout) - FEE: $5 Per Record
Photocopy of hardcopy and/or microfilm documents - FEE: $20 Per Year
Current Record
Owner as of date _____/_____/_____
Photocopies on file for: _____/_____/_____/_____ (indicate years)
Ownership History
Release of Liability (REG 138) _______ (indicate year submitted)
Other (Explain)
Other (Explain)
INDIVIDUAL/BUSINESS NAME
C2
ADDRESS
CITY
STATE
ZIP CODE
Automated record (computer printout) - FEE: $5 Per Record
C2
All vehicles/vessels registered to individual/business listed in
above (single record or list of 8 or less.)
Inst.
SECTION D – Purpose of request – See Instructions – Permissible Uses of DMV record information
Inst.
SECTION E – Requester’s Certification Statement, Signature and DL/ID Number
I certify under penalty of perjury under the laws of the State of California that the information entered by me on this document is true and correct. The information
received will not be used for any unlawful purpose. I understand that if I provide false information, I may be subject to prosecution for false representation (California
Vehicle Code Section 1808.45.) This is a misdemeanor punishable by a maximum fine of five thousand ($5,000) or a maximum imprisonment of one year in the
county jail or both.
EXECUTED AT CITY
COUNTY
STATE
ZIP CODE
ON (DATE)
SIGNATURE
REQUESTER’S DL/ID NUMBER
X
DMV USE ONLY
Check/MO# _________________ Total $ _______________ |
DL/ID
C.R.
Photo
App |
VR
C.R.
As Of
138
History
ANI
Refund __________________
Other _____________________________ Cashier ID/Date _______________________________________________
Inst.
SECTION F – Requester’s Mailing Label – DO NOT DETACH
REQUESTER’S NAME
MAIL BOTH PAGES TO:
Department of Motor Vehicles
ADDRESS
Public Operations — G199
P.O. Box 944247
CITY
STATE
ZIP CODE
Sacramento, CA 94244-2470
INF 70 (NEW 11/2004) WWW
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