DA Form 3626 Vehicle Registration/Driver Record

DA Form 3626 or the "Vehicle Registration/driver Record" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 3626 - was last revised on June 1, 1978. Download an up-to-date fillable DA Form 3626 down below in PDF-format or look it up on the Army Publishing Directorate website.

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COMPLETED
BY
1. PMAC CODE
2. DECAL NUMBER
4. NAME (Last, first, middle initial)
ISSUING
3. REGISTRATION DATE (Yr, Mo, Day)
5. SOCIAL SECURITY NUMBER
AUTHORITY
6. VEHICLE DESCRIPTION
7. VEHICLE ID NUMBER
a. YEAR
b. MAKE
c. MODEL
d. BODY STYLE e. COLOR
8. GRADE
9. CATEGORY
10. VEHICLE LICENSE
ARMY
AIR FORCE
a. STATE
b. NUMBER
c. YEAR
COAST GUARD
CIVILIAN
VENDOR
NAVY
MARINES
DEPENDENT
LOCAL HIRE
RETIRED
11. ORGANIZATION
12. OPERATOR PERMIT
a. STATE
b. NUMBER
13. ADDRESS (Street, City, State, Zip Code)
DATA REQUIRED BY THE PRIVACY ACT OF 1974
REMARKS
AUTHORITY: Title 10, USC, Sec 3012(g).
PRINCIPAL PURPOSE: The Social Security Number is used for Law Enforcement
purposes as an additional means of identification of subjects, suspects, witnesses or
complainants.
ROUTINE USES: Your Social Security Number is a major item used in processing
machine record and output sequence for Military Police Management Information
Systems.
DISCLOSURE OF YOUR SOCIAL SECURITY NUMBER IS VOLUNTARY.
However, failure to provide your SSN may delay or preclude registration of a
privately owned motor vehicle on the military installation.
VEHICLE REGISTRATION/DRIVER RECORD
For use of this form, see AR 190-5; the proponent agency is Provost Marshall General (PMG)
DA FORM 3626, 1 JUN 1978
EDITION OF 1 MAR 73 IS OBSOLETE AND REPLACES DA FORM 3626-R,
APD LC v1.02ES
PRIVACY ACT STATEMENT, 26 SEP 75, WHICH IS OBSOLETE.
COMPLETED
BY
1. PMAC CODE
2. DECAL NUMBER
4. NAME (Last, first, middle initial)
ISSUING
3. REGISTRATION DATE (Yr, Mo, Day)
5. SOCIAL SECURITY NUMBER
AUTHORITY
6. VEHICLE DESCRIPTION
7. VEHICLE ID NUMBER
a. YEAR
b. MAKE
c. MODEL
d. BODY STYLE e. COLOR
8. GRADE
9. CATEGORY
10. VEHICLE LICENSE
ARMY
AIR FORCE
a. STATE
b. NUMBER
c. YEAR
COAST GUARD
CIVILIAN
VENDOR
NAVY
MARINES
DEPENDENT
LOCAL HIRE
RETIRED
11. ORGANIZATION
12. OPERATOR PERMIT
a. STATE
b. NUMBER
13. ADDRESS (Street, City, State, Zip Code)
DATA REQUIRED BY THE PRIVACY ACT OF 1974
REMARKS
AUTHORITY: Title 10, USC, Sec 3012(g).
PRINCIPAL PURPOSE: The Social Security Number is used for Law Enforcement
purposes as an additional means of identification of subjects, suspects, witnesses or
complainants.
ROUTINE USES: Your Social Security Number is a major item used in processing
machine record and output sequence for Military Police Management Information
Systems.
DISCLOSURE OF YOUR SOCIAL SECURITY NUMBER IS VOLUNTARY.
However, failure to provide your SSN may delay or preclude registration of a
privately owned motor vehicle on the military installation.
VEHICLE REGISTRATION/DRIVER RECORD
For use of this form, see AR 190-5; the proponent agency is Provost Marshall General (PMG)
DA FORM 3626, 1 JUN 1978
EDITION OF 1 MAR 73 IS OBSOLETE AND REPLACES DA FORM 3626-R,
APD LC v1.02ES
PRIVACY ACT STATEMENT, 26 SEP 75, WHICH IS OBSOLETE.
14. INSTRUCTIONS TO REGISTRANT
Information on the reverse of this form should be updated as significant changes occur. The operation of a POV on a military installation is a
privilege extended by the Installation Commander subject to compliance with appropriate State laws pertaining to financial responsibility, safety
inspections and registration; to conditions established in paragraph 2-1, AR 190-5 and AR 190-5-1; and other appropriate regulations. Failure to
comply with such laws and regulations may result in an administrative suspension or revocation of driving privileges or termination of installation
registration. The registrant must remove the registration decal from the registered vehicle upon PCS, termination of employment, or sale of POV.
(Date)
(Registrant's signature)
15. RECORD OF ACCIDENTS/MOVING TRAFFIC VIOLATIONS
POINTS ASSESSED
INSTL
VEHICLE
REPORT NO./
TYPE ACCIDENT/VIOLATION
DISPOSITION
CHARG-
CUMULA
DATE
ON
OFF GOVT POV
ED
TIVE
(Include information concerning suspension, revocation of driving privileges, driver improvement measures and participation in
16. REMARKS
rehabilitation or treatment programs)
APD LC v1.02ES

Download DA Form 3626 Vehicle Registration/Driver Record

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