Form DO-21A "Notarized Authorization to Release Personal Motor Vehicle Information" - New Jersey

What Is Form DO-21A?

This is a legal form that was released by the New Jersey Motor Vehicle Commission - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the New Jersey Motor Vehicle Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DO-21A by clicking the link below or browse more documents and templates provided by the New Jersey Motor Vehicle Commission.

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Download Form DO-21A "Notarized Authorization to Release Personal Motor Vehicle Information" - New Jersey

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Notarized Authorization to Release
Personal Motor Vehicle Information
I, ______________________________ grant permission to _____________________________ to
(Name of Grantor)
(Name of Recipient)
receive my personal driver history record and any other motor vehicle information requested by
_______________________________ deemed appropriate by the Motor Vehicle Commission for
(Name of recipient)
Release under the New Jersey Driver’s Privacy Protection Act, N.J.S.A39:2-3.3 et seq.
___________________________________
______________________________
Signature of Grantor
Driver’s License Number of Grantor
___________________________________
______________________________
Street Address
Date
___________________________________
City, State, Zip Code
Subscribed and sworn to before me, the undersigned authority,
On this ____________day of __________, 20_____.
_____________________________
Notary Public in and for the County of
_____________
___________
State
_______________
My Commission expires
Seal
This form, when properly completed and signed, will be accepted by the New Jersey Motor Vehicle Commission as
satisfactory authorization to release personal motor vehicle information concerning the individual named above to
the second party named above.
THIS FORM WILL NOT BE ACCEPTED UNLESS IT IS ACKNOWLEDGED BY A
NOTARY PUBLIC OR LICENSED ATTONEY AT LAW
Visit us at
www.NJMVC.gov
New Jersey is an Equal Opportunity Employer
DO-21A (R10/19)
Notarized Authorization to Release
Personal Motor Vehicle Information
I, ______________________________ grant permission to _____________________________ to
(Name of Grantor)
(Name of Recipient)
receive my personal driver history record and any other motor vehicle information requested by
_______________________________ deemed appropriate by the Motor Vehicle Commission for
(Name of recipient)
Release under the New Jersey Driver’s Privacy Protection Act, N.J.S.A39:2-3.3 et seq.
___________________________________
______________________________
Signature of Grantor
Driver’s License Number of Grantor
___________________________________
______________________________
Street Address
Date
___________________________________
City, State, Zip Code
Subscribed and sworn to before me, the undersigned authority,
On this ____________day of __________, 20_____.
_____________________________
Notary Public in and for the County of
_____________
___________
State
_______________
My Commission expires
Seal
This form, when properly completed and signed, will be accepted by the New Jersey Motor Vehicle Commission as
satisfactory authorization to release personal motor vehicle information concerning the individual named above to
the second party named above.
THIS FORM WILL NOT BE ACCEPTED UNLESS IT IS ACKNOWLEDGED BY A
NOTARY PUBLIC OR LICENSED ATTONEY AT LAW
Visit us at
www.NJMVC.gov
New Jersey is an Equal Opportunity Employer
DO-21A (R10/19)