Form BDVR-155 "Record Request for Michigan Government Agencies" - Michigan

What Is Form BDVR-155?

This is a legal form that was released by the Michigan Department of State - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 5, 2021;
  • The latest edition provided by the Michigan Department of State;
  • 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 BDVR-155 by clicking the link below or browse more documents and templates provided by the Michigan Department of State.

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Download Form BDVR-155 "Record Request for Michigan Government Agencies" - Michigan

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RECORD REQUEST FOR MICHIGAN GOVERNMENT AGENCIES
MICHIGAN DEPARTMENT OF STATE
PRINT FORM
CLEAR FORM
PLEASE PRINT OR TYPE INFORMATION REQUESTED
SECTION 1. REQUESTOR’S INFORMATION
(C
)
OMPLETE ALL FIELDS
MICHIGAN GOVERNMENT AGENCY’S NAME
DAYTIME PHONE NUMBER
(
)
REPRESENTATIVE’S NAME AND TITLE
REFERENCE NUMBER
MAILING ADDRESS
CITY
STATE
ZIP
SECTION 2. MICHIGAN DEPARTMENT OF STATE ACCOUNT NUMBER
(S
I
)
EE
NSTRUCTIONS
This agency has been assigned this Michigan Department of State Account Number: ________________________.
SECTION 3. DRIVER’S RECORD / STATE ID CARD SEARCH
(C
S
3
)
OMPLETE
ECTION
ONLY IF REQUESTING DRIVER
S RECORD OR STATE ID CARD INFORMATION
C
HECK THIS BOX IF YOU WANT A CERTIFIED COPY
DRIVER’S RECORD/STATE ID CARD SEARCH (CHECK BOXES THAT APPLY)
PRIMARY REASON FOR REQUEST
Driver’s Record or State ID Card Record (shows last reported address)
Employment – CDL required
Original License Issue Date
Employment – CDL not required
Current Application
Credit or Insurance
Application History – Complete*
Court
Application History – Partial* From ____________ to ____________
Other (explain)
Address History – Complete*
___________________________________
Address History – Partial* From ____________ to ____________
___________________________________
Other Driving‐Related Records (specify if hearing, offense, license status, etc.)
________________________________________________ Date: ____________
MI DRIVER’S LICENSE OR STATE ID NUMBER
FULL NAME (FIRST, MIDDLE, LAST, AND SUFFIX)
DATE OF BIRTH
SECTION 4. VEHICLE TITLE/REGISTRATION/DISABILITY PLACARD SEARCH
(C
S
4
)
OMPLETE
ECTION
ONLY IF REQUESTING SPECIFIC VEHICLE OR DISABILITY PLACARD INFORMATION
C
HECK THIS BOX IF YOU WANT A CERTIFIED COPY
VEHICLE/TITLE SEARCH (INCLUDES WATERCRAFT & MOBILE HOMES)
Current Ownership/Current Lienholder
Current Title Application and Related Forms
Complete Title History*
Partial Title History* From ____________ to ____________
Insurance information is not retained by MDOS and is not available.
Date of Accident ____________
VIN/HIN/SERIAL #
MAKE
YEAR
FOR OFFICE USE ONLY
DO NOT WRITE IN THIS SPACE
BDVR‐155 (03/05/2021)
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RECORD REQUEST FOR MICHIGAN GOVERNMENT AGENCIES
MICHIGAN DEPARTMENT OF STATE
PRINT FORM
CLEAR FORM
PLEASE PRINT OR TYPE INFORMATION REQUESTED
SECTION 1. REQUESTOR’S INFORMATION
(C
)
OMPLETE ALL FIELDS
MICHIGAN GOVERNMENT AGENCY’S NAME
DAYTIME PHONE NUMBER
(
)
REPRESENTATIVE’S NAME AND TITLE
REFERENCE NUMBER
MAILING ADDRESS
CITY
STATE
ZIP
SECTION 2. MICHIGAN DEPARTMENT OF STATE ACCOUNT NUMBER
(S
I
)
EE
NSTRUCTIONS
This agency has been assigned this Michigan Department of State Account Number: ________________________.
SECTION 3. DRIVER’S RECORD / STATE ID CARD SEARCH
(C
S
3
)
OMPLETE
ECTION
ONLY IF REQUESTING DRIVER
S RECORD OR STATE ID CARD INFORMATION
C
HECK THIS BOX IF YOU WANT A CERTIFIED COPY
DRIVER’S RECORD/STATE ID CARD SEARCH (CHECK BOXES THAT APPLY)
PRIMARY REASON FOR REQUEST
Driver’s Record or State ID Card Record (shows last reported address)
Employment – CDL required
Original License Issue Date
Employment – CDL not required
Current Application
Credit or Insurance
Application History – Complete*
Court
Application History – Partial* From ____________ to ____________
Other (explain)
Address History – Complete*
___________________________________
Address History – Partial* From ____________ to ____________
___________________________________
Other Driving‐Related Records (specify if hearing, offense, license status, etc.)
________________________________________________ Date: ____________
MI DRIVER’S LICENSE OR STATE ID NUMBER
FULL NAME (FIRST, MIDDLE, LAST, AND SUFFIX)
DATE OF BIRTH
SECTION 4. VEHICLE TITLE/REGISTRATION/DISABILITY PLACARD SEARCH
(C
S
4
)
OMPLETE
ECTION
ONLY IF REQUESTING SPECIFIC VEHICLE OR DISABILITY PLACARD INFORMATION
C
HECK THIS BOX IF YOU WANT A CERTIFIED COPY
VEHICLE/TITLE SEARCH (INCLUDES WATERCRAFT & MOBILE HOMES)
Current Ownership/Current Lienholder
Current Title Application and Related Forms
Complete Title History*
Partial Title History* From ____________ to ____________
Insurance information is not retained by MDOS and is not available.
Date of Accident ____________
VIN/HIN/SERIAL #
MAKE
YEAR
FOR OFFICE USE ONLY
DO NOT WRITE IN THIS SPACE
BDVR‐155 (03/05/2021)
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REGISTRATION/PLATE & DISABILITY PLACARD SEARCH
Complete Registration History*
Partial Registration History* From ____________ to ____________
Date of Accident ____________
Insurance information is not retained by MDOS and is not available.
Disability Placard Number: ____________
PLATE OR REGISTRATION #
SECTION 5. VEHICLE SEARCH – ANY & ALL ASSETS
(C
S
6
)
OMPLETE
ECTION
ONLY IF REQUESTING ANY AND ALL ASSETS REGISTERED TO AN INDIVIDUAL OR COMPANY
C
HECK THIS BOX IF YOU WANT A CERTIFIED COPY
When requesting records for all assets registered and/or titled through the Michigan Department of State for individuals and/or
companies, precise information is required. Information retrieved is based upon an exact name and address match. The name and
address, as provided by the record requestor, must match the name and address on the record(s) held by the Michigan Department of
State.
SEARCH
All assets registered or titled to this owner (includes all motor vehicles, watercraft, ORV, snowmobiles, mobile homes, mopeds,
disability plates, etc.) *
VEHICLE OWNER’S NAME (EXACT NAME AS REGISTERED OR TITLED)
VEHICLE OWNER’S ADDRESS (EXACT ADDRESS AS REGISTERED OR TITLED)
CITY
STATE
ZIP
SECTION 6. REQUESTOR’S CERTIFICATION
(C
)
OMPLETE ALL FIELDS
I certify that this requested record information is for use by a federal, state, or local governmental agency, including a court or law
enforcement agency in carrying out the agency’s functions. I also certify that the information and statements on this request are true,
correct, and comply with the provisions of state and federal driver privacy laws. I understand that the willful unauthorized disclosure of
personal information obtained from these record(s) for a purpose not outlined by my government employing agency, or the sale or
other redisclosure of information to a person or organization not identified in this request, may result in penalties imposed under MCL
28.295a, 257.902, 257.903, 324.80130d, 324.80319a, 324.81120, 324.82160 and other provisions of law.
__________________________________________________________________________________________
_______________________________________
SIGNATURE OF REQUESTOR
DATE
Penalties for Misuse: Under Michigan law, a person who makes a false representation or a false certification to obtain personal
information or who uses personal information for a purpose other than a permissible purpose identified in law is guilty of a felony,
which may be punishable by imprisonment for up to 5 years and/or a fine of up to $5,000. Subsequent convictions may result in
imprisonment for up to 15 years and/or a fine up to $15,000.
BDVR‐155 (03/05/2021)
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MICHIGAN GOVERNMENT AGENCIES RECORD REQUEST INSTRUCTIONS
PLEASE READ INSTRUCTIONS CAREFULLY
GENERAL INFORMATION
If you are not requesting information on behalf of a Michigan Government Agency, use form BDVR‐154 to request your own or someone
else’s record.
Accurate and complete information must be provided in order to help us locate the record(s) you want. Records will only be mailed to
the address listed on your Michigan Department of State account. Include a daytime telephone number in case we have questions about
your request.
NEW GOVERNMENT ACCOUNTS
If your agency is a governmental entity and you do not have an account, you can apply for an account on
e‐Services
under the Additional
Services Section and the Record Sales Services hyperlink.
SECTIONS 1, 2 & 6 – REQUIRED INFORMATION
These sections must be completed for your request to be processed. Incomplete or illegible forms will delay processing of your request.
SECTION 3 – DRIVER’S RECORD / STATE ID CARD SEARCH
Complete Section 4 only if you are requesting driver’s record or state identification card information. Include first name, middle name,
last name, suffix, if applicable, and date of birth. If you just need the name, address, or driving status, request the current record only.
IMPORTANT: If you only need a driver’s record or state ID card record, do not complete Sections 4 or 5.
SECTION 4 – VEHICLE REGISTRATION OR TITLE INFORMATION
Complete Section 5 only if you are requesting vehicle registration, title, or disability placard information. For vehicle information,
include as much detail as possible. The owner’s name should be the owner of record, not a purchaser who has not yet titled the
vehicle. If you just need name, address, or ownership verification, request only a current title record. Information about proof
of insurance is not retained and is not available.
For vehicle title information, provide the vehicle identification number (VIN), make, and year.
-
-
For watercraft title information, provide the hull identification number (HIN), make, and year.
For snowmobile, ORV, or mobile home information, provide the serial number, make, and year.
-
-
For vehicle registration information, provide the plate or registration number.
For watercraft registration information, provide the registration (MC) number.
-
Include as much information as you can about watercraft, snowmobile, ORV, or mobile home record requests.
-
-
For disability placard information, provide the disability placard number.
SECTION 5 – VEHICLE SEARCH – ANY & ALL ASSETS
If you request record information on a specific individual, all other names appearing within the documents that you receive will
be redacted (not revealed). Example: If you need all the names associated with a vehicle title history and you provide what you
think is the current owner’s name, all other names within the documents you receive will be redacted. Leave the owner’s
information blank if you need personal information about all owners within the records. You must have a permissible purpose as
outlined by state and federal laws to obtain personal information on all owners. If you do not have a valid permissible purpose,
personal information will be redacted from the record(s) you receive.
IMPORTANT: If you only need vehicle registration or title information, do not complete Section 3.
MAIL COMPLETED FORMS TO
MICHIGAN DEPARTMENT OF STATE
RECORD SALES UNIT
7064 CROWNER DRIVE
LANSING, MI 48918‐1502
CALL 517‐335‐6198 IF YOU NEED HELP COMPLETING THIS FORM. ATTACH ADDITIONAL PAGES, IF NECESSARY.
BDVR‐155 (03/05/2021)
PAGE 3
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