Clear Form
M
D
S
ICHIGAN
EPARTMENT OF
TATE
R
L
R
G
A
ECORD
OOKUP
EQUEST FOR
OVERNMENTAL
GENCIES
If you are not requesting information for a Governmental Agency, use form BDVR-153 if requesting
your own record, or form BDVR-154 if you are requesting records on someone other than yourself.
Section 1. Requestor’s Information (Please print or type all information.)
Governmental Agency Name
Representative’s Name and Title
Mailing Address
File or Claim Number
City
State
Zip Code
Daytime Telephone Number
(
)
-
Section 2. Michigan Department of State Account Number
To my knowledge, this agency has not been assigned a Michigan
Michigan Department of State Account Number
Department of State Account Number. A cover letter on the Agency
______________________________________
letterhead is enclosed, requesting an account number be issued for
current and future use.
Certified record(s) needed
Section 3. Driver/Personal ID Information (If you only want a driving record, leave Section 4 blank.)
Check boxes that apply:
Driving Record
Employment, Credit, or Insurance
For:
Personal ID Record
Court
(Shows last reported address)
Other: ________________________________
Current Application
Application History
For partial histories, please complete: from
to
______/______/______
______/______/______
Address History
Other Driving-Related Record(s) ___________________________________________________ Date
______/______/______
(Hearing, Offense, License Status, etc.)
Individual’s Full Name
Driver’s License/Personal ID Number
Date of Birth
(First, Middle, Last)
Individual’s Full Name
Driver’s License/Personal ID Number
Date of Birth
(First, Middle, Last)
Section 4. Registration or Title Information (Insurance information is not retained and is not available.)
License Plate or
Vehicle
Make and Model
Vehicle or Hull Identification Number
Registration Number
Year
Check boxes that apply:
Current Vehicle Owner and Lienholder Information
Registration Information as of ____/____/____
Copy of Current Title Application and Related Forms
Complete Title History
Complete Registration History
Partial Title History
For partial histories, please complete: from
to
______/______/______
______/______/______
Partial Registration History
Check box if you want:
All motor vehicles registered or titled to this owner.*
All other registered or titled assets for the owner indicated.*
Vehicle Owner(s) Name
Vehicle Owner(s) Address
City
State
Zip Code
For Office Use Only
BDVR-155 (09/10)
SECTIONS 1, 2 AND 5 MUST BE COMPLETED IN ORDER TO PROCESS YOUR REQUEST FOR RECORDS
1
2
