Fillable Form Arizona Driving Record Request Form

What is the Arizona Driving Record Request form?

The Arizona Driving Record Request form, officially Motor Vehicle Record Request, is a form by the Arizona Department of Transportation (DOT) Motor Vehicle Division (MVD). Residents of Arizona who have driving records in the state department can use the form to request driving and vehicle-related information.

The Federal Driver’s Privacy Protection Act (DPPA) regulates the manner the MVD releases information; thus, before requesting any driving records, it is your responsibility to understand all federal and state laws that govern access to and use of MVD records.

Using the Arizona Driving Record Request form, you can obtain your driving records. Your driving records contain public records about you as a driver. From special dates to violations, your driving records show a collection of your information as a driver in Arizona.

How to fill out the Arizona Driving Record Request form?

The Arizona Driving Record Request form is a two-page document. Answer all the required items to avoid any problems and delays with your request.

Page 1

Requester Information

You will need to provide your personal information and present proof of identification.

Requester Name

Enter your full legal name in the following format: First Name, Middle Name, Last Name, Suffix.

Driver License Number or Other ID

Enter your driver’s license number or any applicable identification number.

Daytime Phone Number

Enter your phone number.

Mailing Address

Enter your full mailing address, including City, State, and ZIP.

Representing

Enter the name of the business or other applicable organization.

Driver Record Type

For Uncertified, you may mark the “39-Month” box. For Certified, you may mark the “5 -year” or “Extended History” box.

Vehicle Record Type

Mark the applicable box. You may mark “Uncertified” or “Certified.”

CDL (Commercial Driver License) Record

If you are requesting your CDL record, mark the “Uncertified” box if applicable.

Other Records

If you are requesting other records, mark the applicable box. You may mark “Lienholder,” “TSS Assignment Notice,” “Vehicle History,” or “Certified Driver Packet (government use only).” If you mark “Vehicle History,” enter the Time Frame. If you mark “Certified Driver Packet,” enter the Violation Date.

Criteria

You will need to provide at least one criteria. If the criteria you will provide results in no record or multiple records, you will have to provide additional criteria to locate your specific record request. You can provide additional criteria during your initial request to avoid delays in processing.

Driver Record — Primary Criteria

Licensee Full Name

Enter your full legal name in the following format: First Name, Middle Name or Initial, Last Name, Suffix,

Arizona Driver License/Customer #

Enter your Arizona Driver’s License or Customer number. There are conditions under this item. If any applies, mark the appropriate box. The options are “Has not applied for license” and “License is suspended or revoked.”

Driver Record — Secondary Criteria

Licensee Date of Birth

Enter your date of birth in the following format: Month, Day, Year.

License Expiration Date

Enter the expiration date of your license in the following format: Month, Day, Year.

Licensee Residence Address

Enter your full residence address, including City, State, and ZIP.

Vehicle Record — Primary Criteria

Vehicle Identification Number

Enter the identification number of your vehicle.

Arizona Plate Number

Enter the plate number of your Arizona-registered vehicle. If no plate has been issued to your vehicle, mark the “No plate has been issued” box.

Owner Full Name

Enter your full legal name in the following format: First Name, Middle Name, Last Name, Suffix.

Vehicle Record — Secondary Criteria

Owner Residence Address

Enter your full residence address, including City, State, and ZIP.

Page 2

If you are requesting your own record, mark the “I am requesting my own record” box. You do not have to mark any of the boxes in the Permissible Use section.

Permissible Use

This section lets you determine the status that authorizes a person or entity to obtain your driving record information. Mark the applicable box to determine the use of the requested information. Select from the following:

• For use by any government agency, including any court or law enforcement agency, in carrying out its functions or any private person or entity acting on behalf of a government agency carrying out its functions.
• For use by an attorney license to practice law or by a licensed private investigator in connection with any civil, criminal, administrative or arbitration proceeding in any court or government agency or before any self-regulatory body, 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. (Enter Professional License Number and Court Name and Case Number, if applicable.)
• For use by any insurer that writes automobile liability or motor vehicle liability policies and that is under the jurisdiction of the department of insurance or insurance support organization or by a self-insured entity or its agents, employees or contractors in connection with claims investigation activities and antifraud activities, rating or underwriting.
• For use by an employer or its agents or insurer to obtain or verify information relating to a holder of a commercial driver license that is required under the commercial motor vehicle safety act of 1986 (49 U.S.C. 31301 through 31317).
• For any other use in response to requests for individual motor vehicle records of the state has obtained the express consent of the person to whom the personal information pertains. (Two Primary Criteria and one Secondary required.)
• For use by any requester if the requester demonstrates he or she has obtained the written consent of the individual to whom the information pertains. (Signed and notarized Consent to Release Motor Vehicle Record-One-Time, form # 96-0463.)

Only if a box Is checked for one or more of the six permissible uses above, may the requester specifically request the person's driver license photograph/image or medical/disability information. Mark the box that applies, you may mark “Uncertified” or “Certified.”

• CDL Use — uncertified: For use by States, Secretary of Information, Driver, Motor Carrier, or Prospective Motor Carrier (49 CFR 384.225)
• For use in connection with matters of at least one of the following: (a) Performance monitoring of motor vehicles, motor vehicle parts and dealers (b) Motor vehicle market research activities, including survey research (c) Removal of non-owner records from the original owner records of motor vehicle manufacturers.
• For use in the normal course of business by a legitimate business or its agents, employees, contractors, but only: (a) To verify the accuracy of personal information submitted by the individual to the business or its agents, employees or contractors; or (b) If the information submitted is not correct or no longer correct, to obtain the correct information for the purpose of preventing fraud by, pursuing legal remedies against or recovering on a debt or security interest against the individual. (Enter Federal Tax Identification/Vendor of Professional License Number and Applicable Licensing Agency.)
• For use in research activities and for use in producing statistical reports of the personal information is not published, re-disclosed or used to contact individuals.
• For use in providing notice to the owners of towed for impounded vehicles.
• For use by any licensed private investigative agency or licensed security service, as indicated permissible use. (You must check a second permissible use.)
• For use in connection with the operation of private toll transportation facilities.
• For any other use that is specifically authorized by law and that is related to the operation of a motor vehicle or public safety, including the following :
  • (a) Use by a financial institution or enterprise under the jurisdiction of the Department of Financial Institutions or a federal monetary authority
  • (b) Use by a motor vehicle dealer who is licensed and bonded by the Department or a state organization of licensed and bonded motor vehicle dealers
  • (c) Use by a person who is involved in an accident or the owner of a vehicle involved in an accident the person who requests the information submits proof to the Department of involvement in the accident
  • (d) Use by a person applying for a bonded title if the following conditions exist: (i) The requester verifies to the satisfaction of the Director that the vehicle on which the requester is requesting the record is in the requester’s possession (ii) The record is requested in order for the request to notify the registered owner of the requester’s intent to apply to the Department for a bonded title (iii) The requester provides a verification of a vehicle inspection that was performed by an authorized Department employee or agent.
  • (e) Use by an operator of a self-service storage facility who alleges both of the following: (i) That the vehicle on which the operator is requesting the record is in the operator’s possession (ii) That the record is requested to allow the operator to notify the registered owner and any lienholders of record of the operator’s intent to foreclose its lien and to sell the vehicle.

How much are the fees to request records and documents?

The following are the applicable fees:

• No fee required for government agencies
• Lienholder report — $1.50
• Over-the-Counter (while you wait) — $3.00 (Uncertified), $5.00 (Certified)
• Mail-in (must be notarized) — $3.00 (Uncertified), $5.00 (Certified)
• Drop-off — $2.00 (Uncertified), $5.00 (Certified)
• Supporting microfilm documents — $3.00 (Uncertified), $5.00 (Certified)
• VIN Search for each month searched — $2.00 (Uncertified), $5.00 (Certified)