Form Mv-4 - Government Records Request Form
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1
2New Jersey
Motor Vehicle Commission
Trenton, New Jersey 08666
GOVERNMENT RECORDS REQUEST FORM
IMPORTANT NOTICE:
The reverse side of this form contains important information related to your rights to request government records.
Please read it carefully. In addition please note that you may complete and submit this form electronically on the
Internet at
If you are requesting information related to Driver & Vehicle Records, DO NOT COMPLETE OR SUBMIT
THIS FORM. Please call 1-888-486-3339 (In State) or 1-609-292-6500 (From Out of State) for the proper
form.
Requestor Information- Please Print Below:
Payment Information
First Name__________________
MI_____Last Name_________________________
Maximum Authorized
Company ____________________________________________________________
Cost $____________
Mailing Address_______________________________________________________
Select Payment Method
City_____________________State_______Zip_________Email _________________
Cash __Check __MO___
Business Hours Telephone
Area Code____ Number ___________Extension______
Fees: Pages 1-10 $0.75@
Pages 11-20 $0.50@
Preferred Delivery: Pick Up____ US Mail _____On-Site Inspect_____
Pages 21 - $0.25@
Delivery:
Circle One: Under penalty of N.J.S.A. 2C:28-3, I certify that I HAVE / HAVE NOT been
Delivery/postage fees
convicted of any indictable offense under the laws of New Jersey or any other state of the
depending upon delivery
United States.
type
Extras: Extraordinary
service fees dependent
Signature____________________________ Date__________________________
upon request.
Record Request Information
To expedite your request be as specific as possible in describing the records being requested. Also, please include the
type of access requested (copying, inspection, or examination); and if data, the medium requested.
Please return completed form to: Official Custodian of Records, Motor Vehicle Commission,
PO Box 122, 225 East State Street, Trenton, NJ 08666-0122 Attn: Manager, IUR
New Jersey is an Equal Opportunity Employer
MV-4
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