Form 735-7297 - Notarized Permission Slip To Request Oregon Dmv Records printable pdf download

Form 735-7297 - Notarized Permission Slip To Request Oregon Dmv Records

DMV

NOTARIZED PERMISSION SLIP TO

REQUEST OREGON DMV RECORDS

DEPARTMENT OF TRANSPORTATION

DRIVER AND MOTOR VEHICLE SERVICES

1905 LANA AVE NE, SALEM OREGON 97314

By signing this form, you are giving permission to request your personal information from Oregon DMV records (Name,

Address, Driver License, Driver Permit or Identification Card Number, and Telephone Number) to a person who is not

otherwise entitled by law to obtain this information. A new form must be completed each time personal information is

requested by a person who is not otherwise entitled by law to obtain this information. You do not need this form to request

your own DMV records.

I, _____________________________________________ , Oregon Customer Number __________________________ ,

(Print Full Name)

(Driver License / Permit or ID Card Number)

Date of Birth________________ , give permission to _____________________________________________________ ,

(MM/DD/YYYY)

(Print Full Name)

to request a copy of my driver and/or vehicle record information from Oregon DMV that may include any or all of the

following personal information about me: Name, Address, Driver License, Driver Permit or Identification Card Number,

and Telephone Number.

Please FAX records to:

Or mail to:

READ CAREFULLY:

Records ordered at a DMV field office are mailed or faxed from DMV Headquarters in Salem. Record fees must be paid in

full by check, money order, or cash, only at the time of the order.

This form must be signed before a Notary. You are responsible for any Notary fees.

SIGNATURE

DATE

– To Be Completed By Notary –

State of _______________________ County of _______________________

Subscribed and sworn before me this _________ day of __________, 20 ___

by ___________________________________________________________.

SIGNATURE OF NOTARY PUBLIC

STOP • DO NOT WRITE IN THE AREA BELOW • FOR DMV OFFICE USE ONLY

CUSTOMER ID NUMBER

COUNTER DATE STAMP

TSR ID

735-7297 (9-06)

STK# 300150

Form 735-7297 - Notarized Permission Slip To Request Oregon Dmv Records