Form MV-15C Request for Driving Record Information - New York

Form MV-15C or the "Request For Driving Record Information" is a form issued by the New York State Department of Motor Vehicles.

Download a PDF version of the Form MV-15C down below or find it on the New York State Department of Motor Vehicles Forms website.

ADVERTISEMENT
MV-15C (2/18)
REQUEST FOR DRIVING RECORD INFORMATION
Driver records contain the following information:
convictions, suspensions, revocations, accidents, accident prevention course completion (for more information, refer to f
orm DS-242.1)
w
DMV records do not contain the following information:
tickets, address history, convictions and/or accidents beyond their retention period, date first licensed, vehicle information
w
You can request your record.
You can request another person’s record.
INSTRUCTIONS:
w
A separate form, MV-15C, must be used for each search requested.
You must show documents to prove your identity (see form ID-44 for acceptable proofs of identity).
w
w
The Vehicle and Traffic Law requires that DMV charge a $10 search fee. You must pay the fee even if the driver record is not found.
You can pay the fee with a check made payable to “Commissioner of Motor Vehicles”. According to section 202 of the Vehicle and Traffic Law,
the fee to search a record is not charged to: any public officer, board or body; a volunteer fire company; a volunteer ambulance service; a legal
aid bureau, society or private entity that acts pursuant to Section 722 of the County Law.
If DMV can not find a license record with the information you provide, DMV will send you written notification to advise you that the
requested record was not found.
o
o
I request my own record.
I request another person’s record. (Complete Section A and Section B).
(Complete Section A ONLY)
You must write your initials next to the “permissible use” that applies to your request on Page 2 of this form.
A.
INFORMATION ABOUT THE DRIVER RECORD YOU REQUEST:
DRIVER LICENSE ID#
OR
NAME (Last, First, Middle)
DATE OF BIRTH
SEX
Month
Day
Year
M o F o
B.
YOUR INFORMATION:
DATE OF BIRTH
NAME (Last, First, Middle)
SEX
Month
Day
Year
M o F o
X
Sign Here
Date
Your Signature (required)
CREDIT CARD AUTHORIZATION
My signature authorizes the use of my credit card for payment of any fees in connection with this request. I understand that I must be present for this transaction.
X
Date
Sign Here
(Cardholder-Sign Name in Full)
Proof of Identification Provided by Requester:
o
o
o
o
Client ID #
Driver License/Non-Driver ID Card
Cash
Check
Credit Card
o
Other ID (Specify):
Proof of Qualification for a No Fee Abstract:
o
Name of Organization
Exempt
Claiming Exemption
Purpose of the
Abstract Request
Initials
Date
MVR
X
Signature
THE SPACE BELOW THE LINE IS FOR VALIDATION PURPOSES ONLY.
PAGE 1 OF 2
MV-15C (2/18)
REQUEST FOR DRIVING RECORD INFORMATION
Driver records contain the following information:
convictions, suspensions, revocations, accidents, accident prevention course completion (for more information, refer to f
orm DS-242.1)
w
DMV records do not contain the following information:
tickets, address history, convictions and/or accidents beyond their retention period, date first licensed, vehicle information
w
You can request your record.
You can request another person’s record.
INSTRUCTIONS:
w
A separate form, MV-15C, must be used for each search requested.
You must show documents to prove your identity (see form ID-44 for acceptable proofs of identity).
w
w
The Vehicle and Traffic Law requires that DMV charge a $10 search fee. You must pay the fee even if the driver record is not found.
You can pay the fee with a check made payable to “Commissioner of Motor Vehicles”. According to section 202 of the Vehicle and Traffic Law,
the fee to search a record is not charged to: any public officer, board or body; a volunteer fire company; a volunteer ambulance service; a legal
aid bureau, society or private entity that acts pursuant to Section 722 of the County Law.
If DMV can not find a license record with the information you provide, DMV will send you written notification to advise you that the
requested record was not found.
o
o
I request my own record.
I request another person’s record. (Complete Section A and Section B).
(Complete Section A ONLY)
You must write your initials next to the “permissible use” that applies to your request on Page 2 of this form.
A.
INFORMATION ABOUT THE DRIVER RECORD YOU REQUEST:
DRIVER LICENSE ID#
OR
NAME (Last, First, Middle)
DATE OF BIRTH
SEX
Month
Day
Year
M o F o
B.
YOUR INFORMATION:
DATE OF BIRTH
NAME (Last, First, Middle)
SEX
Month
Day
Year
M o F o
X
Sign Here
Date
Your Signature (required)
CREDIT CARD AUTHORIZATION
My signature authorizes the use of my credit card for payment of any fees in connection with this request. I understand that I must be present for this transaction.
X
Date
Sign Here
(Cardholder-Sign Name in Full)
Proof of Identification Provided by Requester:
o
o
o
o
Client ID #
Driver License/Non-Driver ID Card
Cash
Check
Credit Card
o
Other ID (Specify):
Proof of Qualification for a No Fee Abstract:
o
Name of Organization
Exempt
Claiming Exemption
Purpose of the
Abstract Request
Initials
Date
MVR
X
Signature
THE SPACE BELOW THE LINE IS FOR VALIDATION PURPOSES ONLY.
PAGE 1 OF 2
LIST OF PERMISSIBLE USES
DRIVER PRIVACY PROTECTION ACT
The Federal Driver’s Privacy Protection Act (18 U.S.C. §2721.et seq.) (“DPPA”) regulates access to Motor Vehicles records. Recipient hereby
certifies that the information provided hereunder by DMV shall be used solely for the following purpose(s).
(Recipient must check all that apply.)
1.
Use in any civil, criminal, administrative, or arbitral proceeding in any court or agency, including the service of process, investigation in
anticipation of litigation, and the execution or enforcement of judgments and orders or pursuant to a court order. (18 U.S.C. §2721 (b)(4))
2.
Use by an insurer or insurance support organization or self-insured entity in claims investigations, anti-fraud activities, rating or
underwriting activities. (18 U.S.C. §2721 (b)(6))
Use in providing notice to the owners of towed or impounded vehicles. (18 U.S.C. §2721 (b)(7))
3.
4.
Use by an employer, its agent or insurer to obtain information relating to the holder of a commercial driver's license required under
Chapter 313 of Title 49 of the U.S.C. (18 U.S.C. §2721 (b)(9))
5.
For use in the normal course of business by a legitimate business or its agents, employees, or contractors, but only­
(A) to verify the accuracy of personal information submitted by the individual to the business or its agents, employees, or
contractors; (18 U.S.C. §2721 (b)(3)(A)) and
(B) if such information as so submitted is not correct or is no longer correct, to obtain the correct information, but only for the
purposes of preventing fraud by, pursuing legal remedies against, or recovering on a debt or security interest against, the
individual. (18 U.S.C. §2721 (b)(3)(B))
6.
Use required under NYS Vehicle and Traffic Law, Article 19A - Special Requirements for Bus Drivers. (18 U.S.C. §2721 (b)(14))
7.
Use required under NYS Vehicle and Traffic Law, Article 19B - Special Requirements for Commercial Motor Carriers.
(18 U.S.C. §2721 (b)(14))
8.
Use by any government agency, including any court or law enforcement agency, in carrying out its functions. (18 U.S.C. §2721 (b)(1))
9.
Use by any private person or entity acting on behalf of a federal, state, or local agency in carrying out its functions.
(18 U.S.C. §2721 (b)(1))
10.
Use in matters of motor vehicle or driver safety. (18 U.S.C. §2721 (b)(2))
11.
Use in matters of motor vehicle theft. (18 U.S.C. §2721 (b)(2))
12.
Use in matters of motor vehicle emissions. (18 U.S.C. §2721 (b)(2))
13.
Use in matters of motor vehicle product alterations, recalls or advisories. (18 U.S.C. §2721 (b)(2))
14.
Use in performance monitoring of motor vehicles, motor vehicle parts and dealers. (18 U.S.C. §2721 (b)(2))
15.
Use in motor vehicle market research activities, including survey research. (18 U.S.C. §2721 (b)(2))
16.
Use in removal of non-owner records from the original owner records of motor vehicle manufacturers. (18 U.S.C. §2721 (b)(2))
17.
Use in the operation of private toll transportation facilities. (18 U.S.C. §2721 (b)(10))
18.
For use by any requester, if the requester demonstrates it has obtained the written consent of the individual to whom the information
pertains. (May use form MV-15GC). (18 U.S.C. §2721 (b)(13))
19.
Use specifically authorized under NYS law, IF such use is related to the operation of a motor vehicle or public safety.
Cite the specific NYS law here:
(18 U.S.C. §2721 (b)(14))
20.
Use in research activities and in producing statistical reports,
as long as the personal information is not published, disclosed or
(18 U.S.C. §2721 (b)(5))
used to contact individuals.
To knowingly make a false statement or conceal a material fact in this written statement is a criminal offense, punishable under Penal Law
Section 210.45. In addition, anyone who makes false representation to obtain any personal information from an individual’s Motor Vehicles
record is subject to federal criminal fines under the Driver’s Privacy Protection Act (DPPA).
PAGE 2 OF 2
MV-15C (2/18)

Download Form MV-15C Request for Driving Record Information - New York

1267 times
Rate
4.5(4.5 / 5) 76 votes
ADVERTISEMENT
Page of 2