Sd Eform 0821 V5 - Driver'S Privacy And Protection Act
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3SD EForm - 0821
V5
Complete and use the button at the end to print for mailing.
HELP
Driver’s Privacy and Protection Act
Department of Revenue
Division of Motor Vehicles
445 East Capitol Avenue
Pierre, SD 57501-3185
Attn: Motor Vehicle Record Requester
In accordance with the provisions of the Federal Driver’s Privacy and Protection Act, a written form must be submitted to the
South Dakota Division of Motor Vehicles before certain specific information can be released. Please complete this form and
return it, along with any applicable required fee, to this office. Note: The form must be signed, dated and notarized and
accompanied by the appropriate fee before your request will be processed. Completed forms should be sent to:
SD Division of Motor Vehicles
Attn: Records Search Section
445 East Capitol Avenue
Pierre, SD 57501-3185
Please indicate the nature of your request:
Record Search ($2.00 fee - computer screen printout)
Title History ($5.00 fee - copies of paperwork on microfilm)
If you have any questions, please contact this office at 605-773-3541. Thank you for your cooperation.
Instructions: Only applicants who meet the criteria outlined in Section C are eligible to obtain restricted information. Only one
record allowed per request. Please print your answers clearly.
SECTION A - Requestor Information
Name of Individual Requesting Information:
SD Driver’s License # or Social Security #:
Telephone #:
Federal Employee Identification Number (FEIN):
Representing (Firm, Partnership, Corporation):
Street Address (Physical Location):
(Street Address)
(City)
(State)
(Zip Code)
Mailing Address (If Different):
(Street Address)
(City)
(State)
(Zip Code)
SECTION B - Request to Obtain South Dakota Motor Vehicle Record
Name of Record Holder Being Requested:
SD Drivers License # or Social Security #:
Address:
(Street Address)
(City)
(State)
(Zip Code)
Vehicle Year:
Make:
Vehicle Type (ex.car, motorcycle, etc.):
SD Title/VIN#:
License Plate #:
State of License:
MV/DPPA - 11/08
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