Form 43511 - Request For Bureau Records - Bureau Of Motor Vehicles, State Of Indiana

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State Form 43511 (R2 / 2-96)
Approved by State Board of Accounts, 1994
The Indiana Bureau of Motor Vehicles' records are open to the public. All requests for records must be in writing. Please complete the
following application for drivers license record. You must complete a separate application for each license record you are requesting.
NOTE: The Bureau cannot disclose a person's Social Security number, Federal Identification number, or Driver's License number.
INSTRUCTIONS: Make cashier's check, money order or personal check payable to:
Bureau of Motor Vehicles
Driver Records / IGCN
100 N. Senate Ave., Rm. N405
Indianapolis, IN 46204
TOTAL DUE: $ ________________________
Telephone: (317) 232-2894
Name of person or business making request (first name, middle initial, last name)
Mailing address of person or business making request (number and street or rural route)
ZIP code
Please complete form below for driver information requested. H H H H H H H H H H H H
Name of driver (first name, middle initial, last name)
Driver's license number
Date of birth (month, day, year)
Place a check mark next to the driver information you are requesting.
Driver's License Record (ODR / MVR)
Certification of Record
Fee: $4.00
Fee: $4.00 + (plus)
Record Fee: $ ________
Date of loss (month, day, year)
Name of adverse driver
SR 21 - Proof of Insurance
at Time of Accident
Fee: $4.00
Location of accident
Name of insured driver
Driver's License History
Fee: $8.00
A driver's license history is a driver record plus photo copies of underlying documents:
Please specify documents being requested:
Driver's License
A driver's license record includes:
Driver"s History
A driver's history includes all information
Record (ODR / MVR)
Fee: $8.00
listed under Driver's License records and
1. Driver's name and address
Fee: $4.00
photo copies of SPECIFIED documents.
2. Physical description
Processing time is approximately 2 - 8
3. Type of license issued, status and any
4. Issue and expiration date
5. List of tickets / violations etc.
A certified record is admissible in a court of
Processing time is 7 - 10 working days.
of Records
law. The record is certified as being a copy
Fee: $4.00 plus
of the original documents.
Record Fee
SR 21's
Proof of insurance at the time of an acci-
Proof of Insurance
dent. It takes approximately 120 days, from
Fee: $4.00
the date of the accident, before the informa-
tion is available to the customer.


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