Form 769 - Vehicle Information Request - Oklahoma Tax Commission - Motor Vehicle Division
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1
2Form 769
Revised 10-2014
OTC
Oklahoma Tax Commission
Motor Vehicle Division
Date of Request
Total Amount Remitted with Form 769
Vehicle Information Request
(One form per each vehicle)
I hereby request ownership/lienholder information on the following vehicle:
*VIN:______________________________________________ *License Plate:_________________________________
Year:__________________
Make:_____________________
*Registration Decal:_____________________________
*Title Number:_______________________________________ Vehicle Type: __________________________________
*=At least one (1) of these items is required to access record.
(I.E.: Car, Truck, Trailer, Etc.)
Warning
Federal and State law provide that a person making a false statement for the purpose of obtaining vehicle ownership information, or using the in-
formation for any purpose other than that use permitted by law, is unlawful and subject to criminal fines and or imprisonment. In addition, federal
law provides for possible civil action, where remedies may include actual and punitive damages plus reasonable court costs.
TO GUARANTEE RETURN OF YOUR REQUEST, THIS SECTION MUST BE COMPLETED. A NOTARY SEAL IS REQUIRED.
I understand the information being provided is confidential under Federal and State law and is being released to me only for the reason I have
indicated below and is to be released to no other entity.
Signature: _____________________________________ Printed Name of Individual: __________________________________
(Required)
(Required)
Company, if applicable: ____________________________________________________________________________________
(Print name of company, wrecker/towing service, or governmental court or law enforcement agency)
Address: _______________________________________________________________________
City: ____________________________________ State: _______ ZIP Code: _______________
Subscribed and sworn to before me this _______ day of _____________________ , _________.
My commission expires ___________________, _____________ .
____________________________________________________________ , Notary Public
Notary Seal
YOU MUST CONFIRM YOUR ELIGIBILITY TO RECEIVE THE REQUESTED INFORMATION BY SELECTING THE APPROPRIATE
STATEMENT BELOW (CHECK ONE):
I am the current owner. (If not the record owner, attach proof of purchase.)
I am requesting the information on behalf of the current owner. (Written authorization from record owner is required.)
I represent a licensed wrecker/towing service identified above and the information will only be used to notify owners of
towed or impounded vehicles. Department of Public Safety Wrecker/Towing service license number:______________
The information is to be used by a legitimate business identified above or its agents, employees or contractors for use in
the normal course of business only:
A.
To verify the accuracy of personal information submitted by the individual to the business or its agents, employees
or
B.
If such information as submitted is not correct, or no longer correct, to obtain the correct information for the sole purpose
of preventing fraud by pursuing legal remedies against, or recovering on a debt or security interest against, the individual.
The information is to be used in conjunction with a civil, criminal, administrative, or arbitral proceeding in a federal, state, or
local court or agency or before any self regulating body, including service of process investigation in anticipation of litigation
and the execution or enforcement of a judgement or order, or pursuant to an order of any court.
The information is to be used by an Insurer or insurance support organization identified above, or by a self insured entity or
its agents, employees, or contractors in connection with claims investigation activities, antifraud activities, rating or
underwriting.
I represent a licensed private investigative agency or licensed security service identified above and the information will be
utilized for one of the above listed purposes.
I represent a governmental court or law enforcement agency identified above and the information is to be utilized in carrying
out its official function
Insurance Information Release:
I represent a law enforcement agency identified above and insurance information is required in the investigation of an
accident pursuant to the provisions of OS Title 47 § 10-104.
(See reverse side for processing information and fee schedule.)
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