Form Mv-15 - Request For Certified Dmv Records Page 2
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1
2
3STEP
2
REQUESTOR’S INFORMATION
DAYTIME PHONE NUMBER (REQUIRED):
ADDRESS WHERE YOU GET YOUR MAIL (INCLUDE STREET & NO.)
APT #
Check here if the mailing address you provided in Step 1 is
different from the requestor’s address.
CITY
STATE
ZIP CODE
SIGNATURE
X
STEP
3
CHECK THE BOX NEXT TO EACH TYPE OF RECORD THAT YOU WANT (SEARCH INFORMATION REQUIRED)
Provide as much search information as you know about the record(s) you are requesting.
LAST NAME
FIRST
M.I.
DATE OF BIRTH
SEX
N.Y. DRIVER OR NON-DRIVER ID #
MAILING ADDRESS (INCLUDE STREET & NO.)
APT #
CITY
STATE
ZIP CODE
DATE OF VIOLATION
OFFENSE
TICKET NUMBER of SUSPENSION ORDER NUMBER
# of copies
Fee
Total
0
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
______
DRIVING ABSTRACT (displays records for the last 4 years)
x $10
= $_______
each
0
______
DRIVING RECORD HISTORY (Referred to as “LIFETIME ABSTRACT”) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*
x $10
= $_______
each
DMV can only provide this type of abstract to the individual whose name is on the record. Examples of when this may
*
be required include: background checks, bar exam, applicants for a license in U.S. or Canada, and an attorney
reviewing client’s entire record.
If your lawyer, court personnel or someone other than YOU is requesting your Lifetime abstract, they must
*
include form MV-15GC. Go to dmv.ny.gov to get the form.
Note - this history does not always include information that dates back to when a person was originally granted driving
*
privileges. Some information is purged, as required by law.
0
______
ADDRESS HISTORY (only your own address history) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
x $10
= $_______
each
0
______
$10 each
TICKET and DISPOSITION PHOTOCOPY (DMV does not retain parking tickets - contact city, town, or village) . . . . . . .
x
= $_______
0
DRIVER LICENSE REVOCATION/SUSPENSION ORDER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
______
x $10
= $_______
each
IF YOU WANT MORE THAN ONE TICKET, DISPOSITION, OR SUSPENSION ORDER, PLEASE ATTACH A LIST AND INCLUDE $10 FOR EACH ONE
Provide as much search information as you know about the record(s) you are requesting.
LAST NAME
FIRST
M.I.
DATE OF BIRTH
OR
PLATE
YEAR
MAKE
MODEL
VIN #
# of copies
Fee
Total
0
INSURANCE INFORMATION SEARCH/ACTIVITY REPORT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
______
x $10
= $_______
each
If crash/accident related, please include date of crash/accident
0
______
LIST OF AN INDIVIDUAL’S CURRENT AND PREVIOUS VEHICLE REGISTRATION (PLATES) (if available) . . . . . . . . . . .
x $10
= $_______
each
0
______
VEHICLE REGISTRATION (PLATE) ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
x $10
= $_______
each
0
______
VEHICLE REGISTRATION SUSPENSION ORDER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
x $10
= $_______
each
0
VEHICLE TITLE (VIN) ABSTRACT (Owner - only includes active lien information) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
______
x $10
= $_______
each
IF YOU WANT MORE THAN ONE PLATE, VIN ABSTRACT OR SUSPENSION ORDER, PLEASE ATTACH A LIST AND INCLUDE $10 FOR EACH ONE
# of copies
Fee
Total
0
VEHICLE and TRAFFIC LAW BOOKS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
______
x $ 6
= $_______
each
Please calculate the total for each of the items
0
you want and enter the total here
T O TA L D U E
$
STEP
4
PAYMENT METHOD - DO NOT SEND CASH
Make checks payable to the “Commissioner of Motor Vehicles”
Check
Money Order
Exempt
•
Please remember to SIGN YOUR CHECK
•
No starter checks
•
DMV Dial-in account number ___________________
US Funds only
•
MV-15 (6/17)
PAGE 2 0F 3
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