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
TICKET NUMBER of SUSPENSION ORDER NUMBER
DATE OF VIOLATION
OFFENSE
# of copies
Fee
Total
o
0
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DRIVING ABSTRACT (displays records for the last 4 years)
______
x $10
= $_______
each
0
o
*
______
x $10
= $_______
each
DRIVING RECORD HISTORY (referred to as “LIFETIME ABSTRACT”) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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
o
______
x $10
= $_______
each
ADDRESS HISTORY (only your own address history) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
o
0
______
x $10
= $_______
each
TICKET DISPOSITION* (includes photocopy of ticket or copy of electronic record) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*
DMV does not retain parking tickets - contact city, town or village
0
o
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
o
______
x $10
= $_______
INSURANCE INFORMATION SEARCH/ACTIVITY REPORT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
each
o
If crash/accident related, please include date of crash/accident
0
o
______
x $10
= $_______
LIST OF AN INDIVIDUAL’S CURRENT AND PREVIOUS VEHICLE REGISTRATION (PLATES) (if available) . . . . . . . . . . .
each
0
o
______
x $10
= $_______
each
VEHICLE REGISTRATION (PLATE) ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
o
______
x $10
= $_______
VEHICLE REGISTRATION SUSPENSION ORDER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
each
o
0
______
x $10
= $_______
VEHICLE TITLE (VIN) ABSTRACT (Owner - only includes active lien information) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
each
IF YOU WANT MORE THAN ONE PLATE, VIN ABSTRACT OR SUSPENSION ORDER, PLEASE ATTACH A LIST AND INCLUDE $10 FOR EACH ONE
Please calculate the total for each of the items you want and enter the total here
T O TA L D U E
$
STEP
4
PAYMENT METHOD - DO NOT SEND CASH
o
o
o
Make checks payable to the “Commissioner of Motor Vehicles”
l
Check
Money Order
Exempt
Please remember to SIGN YOUR CHECK
l
No starter checks
o
l
DMV Dial-in account number ___________________
US Funds only
l
PAGE 2 0F 3
MV-15 (11/17)
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