Fillable Request Form For Vehicle Information printable pdf download

DMV-100-TR

REV 05/11

West Virginia Department of Transportation

Division of Motor Vehicles

Request for Vehicle Information

Call • 304-926-3909 | Fax • 304-926-3881

PO Box 17150 • Charleston, WV 25317

A.) Requester Information •

Complete all requested information on form (front and back).

(

)

Name

Daytime Telephone

Address

STREET ADDRESS

CITY

STATE

ZIP

•

Please check all sections that apply.

For use by any government agency, including court or law enforcement agency in carrying out it’s functions, or any

private person or entity acting on behalf of a Federal, State or local agency, in carrying out its functions. The agency

making the request must submit a signed letter, on letterhead, explaining why this information is needed.

For use in connection with matters of motor vehicle or driver safety; motor vehicle emissions; motor vehicle product

alterations, recalls, or advisories; performance monitoring of motor vehicles, motor vehicle parts and dealers; motor

vehicle market research activities, including survey research, and removal and non-owner records from the original

owner records of motor vehicle manufacturers.

For use in the normal course of business by a legitimate business or its agents, employees, or contractors, but only:

A.) For the purpose of verifying the accuracy of personal information submitted by the individual to the business or it’s

agents, employees, or contractors; and

B.) If the information as so submitted is not correct or is no longer correct, to obtain the correct information, but only

for the purposes of preventing fraud by pursuing legal remedies against, or recovering on a debt or security interest

against the individual; and

C.) This request must be accompanied by a signed letter, on business letterhead, explaining why this

information is needed.

For use in connection with a civil, criminal, administrative, or arbitral proceeding in any Court or Governmental agency or

before a self-regulatory body, including the service of process, the execution or enforcement of judgments and orders, or

pursuant to any order of a Federal, State, or Local Court. All requests must include the court docket number.

For use by an insurer or insurance support organization, or by a self-insured entity, or its agents, employees, or

contractors in connection with claim investigation activities, anti-fraud activities, rating or underwriting. All requests

must be accompanied by a signed letter, on business letterhead, explaining why this information is needed.

For use in providing notice to the owners of towed or impounded vehicles (ex. abandoned vehicles):

State _______

Lienholder _________________________________________________________________________ Initials _____

For use by any licensed private investigator agency or licensed security service for any purpose permitted by the Uniform

Motor Vehicle Records Disclosure Act §17A-2A-7. All requests must be accompanied by a signed letter, on business

letterhead, from the employer listing a court docket number, insurance claim number, or explanation for the

request from the government agency employing the service.

For use in connection with the operation of private toll transportation facilities.

Individual request. Personal information will be redacted on requests about others unless accompanied by written

consent.

YOU MUST COMPLETE THIS FORM ON THE REVERSE SIDE

Request Form For Vehicle Information

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