Ohio Department Of Public Safety Bureau Of Motor Vehicles Obmv Record Request
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2Softech Acct Number:
OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
OBMV RECORD REQUEST
(Ohio Revised Code [O.R.C.] 4501.15, 4501.27, AND 4507.53)
This agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined
under O.R.C. 4501.27. Disclosure of this information is REQUIRED. FAILURE to provide any information will result in this
form not being processed.
This request is being made by (check one):
An individual inquiring regarding himself or herself: (Complete Part A) If inquiring in person for information on
yourself, you must provide personal information regarding yourself, or prove your identity by presenting your driver
license or identification card.
An individual inquiring regarding another person: (Complete Parts A and B) If inquiring regarding another
individual, you must attach a notarized BMV Form 5008 giving the written consent of the person. All mail requests
without the BMV Form 5008 attached will be returned to the requester.
Other: (Check applicable reason for request on Part C, and complete Parts A and B)
I am requesting the following personal information contained in the Bureau of Motor Vehicles records:
Driving Record
($5.00)
Copy of Title Record
($5.00)
[302]
Vehicle Registration Record
($5.00)
[303]
Last Known Address
($5.00)
[405]
Copy of Driver License Application
($5.00)
[405A]
PART A: Please provide current information regarding yourself:
NOTE: SIGNATURE REQUIRED
SIGNATURE
DATE
YOUR NAME (REQUESTER)
DATE OF BIRTH
X
CURRENT STREET ADDRESS
CITY
STATE
ZIP
COMPANY (IF APPLICABLE)
BMV ACCOUNT # (IF APPLICABLE)
SOCIAL SECURITY #
DRIVER LICENSE #
LICENSE PLATE #
VEHICLE IDENTIFICATION #
TITLE #
TELEPHONE #/FAX #
PART B: Request regarding other person(s):
PERSON’S NAME
DATE OF BIRTH
STREET ADDRESS
CITY
STATE
ZIP
SOCIAL SECURITY #
DRIVER LICENSE #
LICENSE PLATE #
VEHICLE IDENTIFICATION #
TITLE #
If requesting information on more than 1 person or vehicle, attach additional sheet(s).
Additional sheet(s) attached
Make check or money order payable to Ohio Treasurer Josh Mandel. If mailing, return to: Ohio Bureau of Motor Vehicles, Attn:
Records Request, P.O. Box 16520, Columbus, Ohio 43216-6520. Results will be mailed to requester.
NOTE: An additional $3.50 fee will be charged when submitting this form in person to the Customer Service Center located at
1970 W. Broad St., Columbus, OH 43223.
BMV 1173 1/11
Page 1 of 2
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