Driver Privacy Protection Act Authorization To Disclose Personal Information Form Dl-Dppa-2
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1NORTH CAROLINA
DIVISION OF MOTOR VEHICLES
DRIVER LICENSE SECTION
Driver Privacy Protection Act Authorization
To Disclose Personal Information Form DL-DPPA-2
I understand that personal information contained in my Motor Vehicle Record is protected by the federal Driver Privacy
Protection Act and N.C. General Statue 20-43.1. I hereby authorize the release of my personal information to the person
named below.
_____________________________________________
_____________________________________________
Print your full name as it appears on your driver license
Your signature (MUST BE SIGNED)
__________________________________________________________________
_________________________
Your N.C. driver license number, SSN or ITIN & date of birth
Date signed
Person to receive information: ________________________________________________________________________
Mailing address: ___________________________________________________________________________________
Fees: Certified Complete History - $11
Uncertified Complete History -$8
Uncertified Limited History - $8
Circle one of the above to indicate the type of MVR to be released. Make checks payable to “NCDMV”.
Mail this form and fees to: NCDMV, Driver License Records, 3113 Mail Service Center, Raleigh, NC 27699, please
allow 10 business days processing time, this does not include US Postal service delivery time to or from the DMV.
Form DL-DPPA-2, Revised Oct 2005
Previous editions are obsolete, DO NOT USE
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