Form Crd-93 - Information Request
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1INFORMATION REQUEST
CRD-93 (09/01)
CCC USE ONLY
Department of Motor Vehicles
Fee
P.O. Box 27412
Richmond, Va 23269-0001
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Please type or print clearly. Check one or more boxes to show the type(s) of information desired and provide all requested data.
REQUESTOR INFORMATION
Name:
Last
First
Middle
Organizational Affiliation (if any)
Street Address
Telephone Number
(
)
City
State
Zip Code
Federal Tax ID or Social Security Number*
Use Agreement Number (if applicable)
Access Code (if applicable)
Reason for Request (Please be specific)
I understand that it is unlawful to use information provided by DMV for any purpose other than the one stated. I further certify that the information I have requested with this
form will be used only for the stated purpose.
Requestor’s Signature
Date
SUBJECT’S PERSONAL INFORMATION
(includes name and address)
Subject’s Name
Last
First
Middle
Address
City
State
Zip Code
SUBJECT’S DRIVING INFORMATION
(includes license history and conviction data)
Driver’s License Numb
Date of Birth
OR
Driver’s Authorization (required for employers and others not authorized by Virginia code): I authorize the Department of Motor Vehicles to furnish, for this one time only,
information pertaining to my driving record to the requestor identified above.
Driver’s Signature
Date
VEHICLE INFORMATION
(Includes vehicle description and registration data)
Vehicle Identification Number
Vehicle Make
Vehicle Year
ACCIDENT REPORT
Driver’s Name
Driver’s License Number
Date of Accident
OTHER INFORMATION (PLEASE BE SPECIFIC)
DMV Customer Service Center Use ONLY
Proof of Requestor’s Identification
Proof Of Requestor’s Organizational Affiliation
Request on Organization’s Letterhead Stationery
Valid Driver’s License Number ______________________________________
Business Card from Organization
Law Enforcement Badge Number ________________________________
Other Photo ID ___________________________________________________
Other ________________________________________________________
If Referred to Headquarters to Fill Request, Complete:
Remarks/Teller Stamp
Fee Charged
Teller’s Name _________________________________________________________
Customer Service Center Name (not #) ____________________________________
*Required by the State Comptroller for debt set-off collection purposes in accordance with Virginia Code §§2.1-196, 2.1-731, 2.1-734, et al.
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Parent category: Legal