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REQUEST FOR DRIVER RECORDS

State Form 53789 (R9 / 6-13)

Approved by State Board of Accounts, 2013

Bureau of Motor Vehicles

The Indiana Bureau of Motor Vehicles (BMV) driver and vehicle records are open to the public except those protected by law.

Recipients of records must comply with the applicable state and federal privacy laws for usage, distribution, and record keeping.

Many of the BMV public records are immediately available through a subscription to the online service at IN.gov. Your own

records are also immediately available online at . Paper copies may be requested by completing this form.

Records will contain only the personal information submitted with the request unless otherwise authorized by law. “Personal

information”

means anything in the record that identifies a person, including: (1) name; (2) address; (3) driver’s license or

identification document number; (4) a photograph or computerized image; (5) Social Security number; (6) telephone number; or

(7) medical or disability information.

Records will not contain confidential juvenile information, unless you, as the requestor, are the individual to whom the information

belongs, or the parent, legal guardian, or authorized representative of that individual. If you otherwise are entitled to confidential

juvenile information, you must obtain it from the appropriate court.

STEP 1:

Provide the following information for the person completing/submitting this form.

Name of person or business (first name, middle name, last name)

Telephone number E-mail address

Mailing address (number and street, city, state and ZIP code)

Last 4 digits of Social Security number

Federal Identification Number, if applicable

(This information is for security purposes only.)

XXX-XX-

STEP 2:

Person named in Step 1 is requesting information on the following person.

Name of driver (first name, middle name, last name)

Driver’s license number, if known

Last 4 digits of driver’s Social Security number, if known

Driver’s date of birth (mm/dd/yyyy), if known

XXX-XX-

Mailing address (number and street, city, state and ZIP code)

STEP 3:

Select

the type of record(s)

you are requesting.

Certified Driver Record ($4.00 fee) - Requires 10 business days to process.

Certified Driver History ($8.00 fee) - Record and photocopies of supporting documents. Requires 2-4 weeks to process.

:_______________________________________________________________

Specify the documents being requested

Proof of Insurance ($4.00 fee) - Available 120 days after an accident or a ticket.

Name of vehicle owner: _________________________________________________________________________________

Vehicle: Make ________ Model ________ Year _________ Date of accident or ticket (mm/dd/yyyy) _______________

Record Containing Confidential Juvenile Information - I am requesting records that contain confidential juvenile

information, and:

The record belongs to me. You must include a copy of your photo identification.

I am the parent,

legal guardian, or

authorized representative (i.e., POA, Attorney) of the individual to whom

the confidential juvenile information belongs. You must include a copy of your photo identification.

Request For Driver Records

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