Dmv Request For Records - Reilly Newman Page 2
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1
2Authorized Agent:
Knox Attorney Service, Inc.,
REQUEST FOR RECORD INFORMATION
Knox Services LLC.
PART II: Notice to Record Subject
A Public Service Agency
SEE BELOW
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)
SECTION A – Requester’s Information – ALL INFORMATION REQUIRED
REQUESTER’S NAME (FIRST, MI, LAST)
DAYTIME TELEPHONE NUMBER
(
)
ADDRESS
CITY
STATE
ZIP CODE
–
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)
–
C1
C2
SECTION C – VR/VESSEL Record Request ONLY
COMPLETE LINE
OR
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.)
SECTION D – Purpose of request – See Instructions – Permissible Uses of DMV record information
NOTICE TO RECORD SUBJECT
Based on information provided in Section B or Section C, the Requester identified in Section A
has requested information from DMV records. The DMV has determined that the purpose for
requesting the information (Section D) to be in compliance with the California Vehicle Code
§1808, the Information Practices Act of 1977 (Civil Code §1798 et seq.), the Public Records
Act (Government Code §6250 et seq.) and the federal Driver’s Privacy Protection Act (Title 18
United States Code §§2721-2725.)
(DMV USE ONLY) – Confidential residence address information
was
was not provided in accordance with law.
RECORD SUBJECT’S MAILING LABEL – DO NOT DETACH
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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