Form TR-67 A "Request for Motor Vehicle Information (Crash Reports)" - North Carolina

What Is Form TR-67 A?

This is a legal form that was released by the North Carolina Department of Transportation - Division of Motor Vehicles - a government authority operating within North Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2017;
  • The latest edition provided by the North Carolina Department of Transportation - Division of Motor Vehicles;
  • 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 TR-67 A by clicking the link below or browse more documents and templates provided by the North Carolina Department of Transportation - Division of Motor Vehicles.

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Download Form TR-67 A "Request for Motor Vehicle Information (Crash Reports)" - North Carolina

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Official use only__________________
North Carolina Division of Motor Vehicles
Request for Motor Vehicle Information
(Crash Reports)
All motor vehicle records are subject to the Federal Driver’s Privacy Protection Act (FDPPA) and
General Statute 20-43.1. A crash report is a motor vehicle record. The FDPPA and GS 20-43.1
require that personal information in the Division of Motor Vehicles’ records be closed to the
public. Personal information from these records may be released to individuals or organizations
that qualify under one of the fourteen exceptions listed on the back of this form. These exceptions
are summarized statements of permissible uses.
Effective January 1, 2013, only certified crash reports are available from the Division. As
mandated by NCGS 20-42(b) the cost for a certified crash report is $5.00.
******************************************************************
I hereby request a copy of a certified crash report for:
Name of Driver ________________________________ DL# ________________
Date of Crash ___________________ County of Crash ______________________
Choose County...
I am qualified to obtain this information for my own personal record _________ or
I qualify under exception number _________ listed on the reverse side.
My signature on this document acknowledges that I understand that improper release of
information and/or false representations to gain information from DMV’s records are
prohibited acts.
Requested by:
Full Name (Print): ___________________________________ Date: ______________
Signature: _____________________________________________________________
Agency or Company: ____________________________________________________
Street Address: _________________________________________________________
City ____________________________ State ____________ Zip Code ____________
Identification provided: License/ID # _________________________
Other ID (if not License #) ___________________________________________________
For additional information, contact the Crash Reports Unit at 919-861-3068.
The cost for a certified crash report is $5.00.
Make checks payable to NCDMV and mail requests to:
Traffic Records Branch, Crash Reports Unit, 3106 Mail Service Center,
Raleigh, NC 27697-3106
TR-67 A (revised 4/2017)
Official use only__________________
North Carolina Division of Motor Vehicles
Request for Motor Vehicle Information
(Crash Reports)
All motor vehicle records are subject to the Federal Driver’s Privacy Protection Act (FDPPA) and
General Statute 20-43.1. A crash report is a motor vehicle record. The FDPPA and GS 20-43.1
require that personal information in the Division of Motor Vehicles’ records be closed to the
public. Personal information from these records may be released to individuals or organizations
that qualify under one of the fourteen exceptions listed on the back of this form. These exceptions
are summarized statements of permissible uses.
Effective January 1, 2013, only certified crash reports are available from the Division. As
mandated by NCGS 20-42(b) the cost for a certified crash report is $5.00.
******************************************************************
I hereby request a copy of a certified crash report for:
Name of Driver ________________________________ DL# ________________
Date of Crash ___________________ County of Crash ______________________
Choose County...
I am qualified to obtain this information for my own personal record _________ or
I qualify under exception number _________ listed on the reverse side.
My signature on this document acknowledges that I understand that improper release of
information and/or false representations to gain information from DMV’s records are
prohibited acts.
Requested by:
Full Name (Print): ___________________________________ Date: ______________
Signature: _____________________________________________________________
Agency or Company: ____________________________________________________
Street Address: _________________________________________________________
City ____________________________ State ____________ Zip Code ____________
Identification provided: License/ID # _________________________
Other ID (if not License #) ___________________________________________________
For additional information, contact the Crash Reports Unit at 919-861-3068.
The cost for a certified crash report is $5.00.
Make checks payable to NCDMV and mail requests to:
Traffic Records Branch, Crash Reports Unit, 3106 Mail Service Center,
Raleigh, NC 27697-3106
TR-67 A (revised 4/2017)
FEDERAL DRIVER'S PRIVACY PROTECTION ACT
Enacted by Congress August 24, 1994
Ratified into N.C. Law September 13, 1997
that personal information contained in the Division of Motor Vehicles’
Chapter 123, Section 2721 requires
records be closed to the public. This refers to photos, social security numbers, driver’s license numbers, names,
addresses, telephone numbers and medical information.
General Purpose:
The Division of Motor Vehicles, and any officer, employee or contractor, therefore, shall not
knowingly disclose or otherwise make available to any person or entity personal information about any individual
obtained by the division in connection with a motor vehicle record.
Permissible Uses:
Personal information SHALL be disclosed for use in connection with matters of:
A. Motor vehicle or driver safety and theft
B. Motor vehicle emissions
C. Motor vehicle product alterations, recalls or advisories
D. Performance monitoring of motor vehicles and dealers by motor vehicle manufacturers
E. Removal of non-owner records from the original owners if motor vehicle manufacturers to carry out purpose of
the Automobile Information Act, the Motor Vehicle Information and Cost Saving Act, the National Traffic and
Motor Safety Act of 1966, the Anti-Car Theft Act of 1992 and the Clean Air Act.
Exceptions:
Personal information MAY be released for the following reasons: (List qualifying number on reverse)
1.
For use by any government agency, or any private person or entity acting on behalf of a Federal,
State, or local agency in carrying out its functions.
2.
For use in matters of motor vehicle or driver safety and theft, motor vehicle emissions, motor vehicle
product alterations, recalls or advisories, performance monitoring of motor vehicles, motor vehicle parts
and dealers, motor vehicle market research activities, including survey research, and removal of non-owner
records from the original owner records of motor vehicle manufacturers
3.
For use in the normal course of business by a legitimate business, but only:
a.
To verify accuracy of personal information
b.
To obtain correct information, but only for purposes of:
1. Preventing fraud by the individual
2. Pursuing legal remedies against the individual
3. Recovering on a debt or security interest against the individual
4.
For use in connection with any civil, criminal, administrative, or arbitrate proceeding in any Federal, State
or local court or agency (includes the execution or enforcement of judgments and orders or court orders)
5.
For use in research activities and statistical reports
a.
Personal information must not be:
1. Published
2. Redisclosed
3. Used to contact individuals
6.
For use by insurance companies in connection with claims investigation, antifraud
activities, rating or underwriting.
7.
For use in providing notice to owners of towed or impounded vehicles
8.
For use by private investigators or licensed security service
9.
For use by employer to verify information regarding CDL
10.
For use in connection with private toll facilities
11.
For any other use if person has opportunity to refuse disclosure on DMV forms (Prohibited by NC General
Statute 20-43.1).
12.
For bulk surveys, marketing or solicitations (Disclosure must be in accordance with N.C. General Statute
20-43.1).
13.
For use by any requester that has obtained written consent of the individual to whom the information
pertains.
14.
For any use specifically authorized under the law of the State that holds the record, if such use is related to
the operation of a motor vehicle or public safety.
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