Form MV 703 Personal Information Release Form - Delaware

Form MV703 or the "Personal Information Release Form" is a form issued by the Delaware Division of Motor Vehicles.

Download a PDF version of the Form MV703 down below or find it on the Delaware Division of Motor Vehicles Forms website.

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STATE OF DELAWARE
Date:
Division of Motor Vehicles
PERSONAL INFORMATION
DMV Account Number:
RELEASE FORM
Company Name:
Address:
Address continued:
City
State
Zip
Name of Requester and (representative - if requester is not present)
(Print)
Requester’s Home Address:
(Print)
Requester’s Driver License Number:
DL State:
IT IS UNLAWFUL FOR ANY PERSON TO KNOWINGLY OBTAIN OR DISCLOSE PERSONAL INFORMATION
FROM DMV RECORDS EXCEPT AS AUTHORIZED BY STATUTE (PAGE 2). VIOLATORS WILL BE SUBJECT
TO A MINIMUM PENALTY OF $2,500.00. PERSONAL INFORMATION INCLUDES AN INDIVIDUAL’S DRIVER
IDENTIFICATION NUMBER, NAME, AND ADDRESS.
I,
,
I
THE UNDERSIGNED
DO HEREBY AFFIRM THAT
HAVE READ AND UNDERSTAND THE ABOVE STATEMENT AND AGREE TO ABIDE
,
DMV
BY ALL LAWS
TERMS AND STIPULATIONS CONCERNING THE DISCLOSURE OF PERSONAL INFORMATION CONTAINED IN
.
RECORDS
SIGNATURE MUST BE NOTARIZED
IF NOT APPEARING IN PERSON
(Signature of Requester)
Notary Public:
(Signature of Notary)
(Notary Seal/Stamp)
INQUIRY ON:
Name:
Last
First
Middle
Date of Birth:
Delaware License Number:
OR Plate/VIN Number:
(if requesting driving record)
(if requesting vehicle record)
YOU MUST HAVE THE CONSENT OF THE INDIVIDUAL WHO IS THE SUBJECT OF YOUR INQUIRY – OR – YOU MUST
CHECK THE APPLICABLE BOX AND PROVIDE ADDITIONAL INFORMATION AS REQUIRED FOR INFORMATION TO BE
RELEASED BY STATUTE. FAILURE TO PROVIDE EITHER WILL RESULT IN THE DENIAL OF YOUR REQUEST.
RELEASE BY CONSENT OF INDIVIDUAL:
I,
, authorize
(Print “Inquiry On” name)
(Print Name of requester)
to have access to personal information in my DMV records.
(Signature of “Inquiry On” person)
Notary Public:
(Signature of Notary)
(Notary Seal/Stamp)
DO NOT WRITE IN THIS BLOCK
DMV USE ONLY
DO NOT WRITE IN THIS BLOCK
□ Driving Record
□ Vehicle Record
□ Other
Information Provided
DMV Representative:
MV703 (Oct 2015)
Page 1 of 2
STATE OF DELAWARE
Date:
Division of Motor Vehicles
PERSONAL INFORMATION
DMV Account Number:
RELEASE FORM
Company Name:
Address:
Address continued:
City
State
Zip
Name of Requester and (representative - if requester is not present)
(Print)
Requester’s Home Address:
(Print)
Requester’s Driver License Number:
DL State:
IT IS UNLAWFUL FOR ANY PERSON TO KNOWINGLY OBTAIN OR DISCLOSE PERSONAL INFORMATION
FROM DMV RECORDS EXCEPT AS AUTHORIZED BY STATUTE (PAGE 2). VIOLATORS WILL BE SUBJECT
TO A MINIMUM PENALTY OF $2,500.00. PERSONAL INFORMATION INCLUDES AN INDIVIDUAL’S DRIVER
IDENTIFICATION NUMBER, NAME, AND ADDRESS.
I,
,
I
THE UNDERSIGNED
DO HEREBY AFFIRM THAT
HAVE READ AND UNDERSTAND THE ABOVE STATEMENT AND AGREE TO ABIDE
,
DMV
BY ALL LAWS
TERMS AND STIPULATIONS CONCERNING THE DISCLOSURE OF PERSONAL INFORMATION CONTAINED IN
.
RECORDS
SIGNATURE MUST BE NOTARIZED
IF NOT APPEARING IN PERSON
(Signature of Requester)
Notary Public:
(Signature of Notary)
(Notary Seal/Stamp)
INQUIRY ON:
Name:
Last
First
Middle
Date of Birth:
Delaware License Number:
OR Plate/VIN Number:
(if requesting driving record)
(if requesting vehicle record)
YOU MUST HAVE THE CONSENT OF THE INDIVIDUAL WHO IS THE SUBJECT OF YOUR INQUIRY – OR – YOU MUST
CHECK THE APPLICABLE BOX AND PROVIDE ADDITIONAL INFORMATION AS REQUIRED FOR INFORMATION TO BE
RELEASED BY STATUTE. FAILURE TO PROVIDE EITHER WILL RESULT IN THE DENIAL OF YOUR REQUEST.
RELEASE BY CONSENT OF INDIVIDUAL:
I,
, authorize
(Print “Inquiry On” name)
(Print Name of requester)
to have access to personal information in my DMV records.
(Signature of “Inquiry On” person)
Notary Public:
(Signature of Notary)
(Notary Seal/Stamp)
DO NOT WRITE IN THIS BLOCK
DMV USE ONLY
DO NOT WRITE IN THIS BLOCK
□ Driving Record
□ Vehicle Record
□ Other
Information Provided
DMV Representative:
MV703 (Oct 2015)
Page 1 of 2
YOU MUST HAVE THE CONSENT OF THE INDIVIDUAL WHO IS THE SUBJECT OF YOUR INQUIRY – OR – YOU MUST
CHECK THE APPLICABLE BOX AND PROVIDE ADDITIONAL INFORMATION AS REQUIRED FOR INFORMATION TO BE
RELEASED BY STATUTE. FAILURE TO PROVIDE EITHER WILL RESULT IN THE DENIAL OF YOUR REQUEST.
Release Authorized by Statute – Check Block(s) Which Apply
For use by a government agency, including any court of law, enforcement agency, or any private person or
entity acting on behalf of a government, in carrying out its functions (Section 305(b)(1)).
Name of Business:
Address:
Telephone Number: (
)
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; 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.
Name of Business:
Address:
Telephone Number: (
)
For use in connection with any civil, criminal, administrative or arbitration proceeding or pursuant to any
court order.
Case Caption:
vs.
Civil/Criminal Docket Number:
Purpose:
For use by any insurer or insurance support organization, or its agents, employees or contractors in
connection with claims investigation activities, anti-fraud activities, rating or underwriting.
Name of Organization:
Address:
Telephone Number: (
)
For use in providing notice to the owners or lien holders of towed or impounded vehicles.
Name of Organization:
Address:
Telephone Number: (
)
For use by a licensed private investigative agency or licensed security service.
Name of Organization:
Address:
Telephone Number: (
)
PI License Number:
State:
For use by an employer or insurer to obtain information relating to a holder of a Commercial Driver’s
License.
Name of Organization:
Address:
Telephone Number: (
)
MV703
(Oct 2015)
Page 2 of 2
Driving Record Information ONLY:
The personal information contained in motor vehicle records is highly sensitive and protected by federal and state statute.
Large fines may be assessed against any person who improperly releases personal information. Personal information is
defined as any information that identifies an individual, including an individual’s photograph, social security number, driver
license number, name, address, telephone number and medical or disability information. The information pertaining to your
driving history, such as convictions and license status, is public information. The statute allows the release of personal
information when approved by the individual to whom the record pertains or by exception under specific circumstances.
These exceptions are listed on the back of the
Personal Information Release
Form. The Division does not release your
personal information for marketing purposes.
INSTRUCTIONS:
If you are a company/business
and have a valid reason under the statute to receive another’s information, please fill
out the entire form and have it notarized. Failure to do so will result in the denial and return of your request.
1. Date
2. Name and address of company
3. Name of requestor – individual at the business requesting the information and the name of the
representative picking up information.
4. Requester’s home address
5. Requester’s driver license number and state of issuance
6. Read statement in bold print, then sign on requester’s signature line
7. Have notary witness the signature and sign and affix notary’s seal/stamp
8. Complete “Inquiry On” section
9. Either obtain individual’s consent OR check appropriate statute box on page 2 and complete.
10. Attach a letter drafted on business letterhead containing the:
a. Date
b. Name and address of the business
c. Individual’s name and license number of whom the request is for
d. Must be printed on business letterhead and contain a live signature
11. Mail completed request form, business letter, and check or money order made payable to DMV for $25.00
per inquiry to one of the addresses below.
If you are an individual
requesting your own driving record or vehicle record, complete the following lines.
1. Date
2. Name of requestor
3. Requester’s home address – your current mailing address
4. Requester’s driver license number and state of issuance
5. Read statement in bold print, then sign on requester’s signature line
6. Have notary witness the signature and sign and affix notary’s seal/stamp
7. Complete “Inquiry On” section
8. As an individual requesting your own record, you may obtain a 3 year, 5 year, or complete driving record.
Please specify which you require and write across the top of page one of the Personal Information Release Form.
9. Mail completed form and check or money order made payable to DMV for $25.00 per inquiry to one of the
addresses below.
For Driving Records
For Vehicle Records
For Overnight Delivery
(Use FedEx or UPS (not USPS))
Division of Motor Vehicles
Division of Motor Vehicles
Division of Motor Vehicles
ATTN: Driver License Admin
ATTN: Correspondence
303 Transportation Circle
P.O. Box 698
P.O. Box 698
Dover, DE 19901
Dover, DE 19903
Dover, DE 19903
Call 302-744-2506 for questions about driving records or 302-744-2538 for questions about vehicle records.
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