Fillable Form VG-116: Vermont Driver Record Request

What is the Vermont Driving Record Request Form?

Form VG-116, Vermont DMV Record Request, or the Vermont Driving Record Request Form is a document used to request driving records in Vermont.

How to fill out the Vermont Driving Record Request Form?

Under the Driver Privacy Protection Act (DPPA), all personal information must be disclosed for permissible uses only. If your purpose for your information request does not qualify the purposes mentioned at the back of the Vermont Driving Record Request Form, you cannot make this request. Otherwise, you will be subjected to penalties under 18 U.S. Code § 2723 of the DPPA.

Requester Name

Enter your name.

DBA/Company

Enter the operating name or legal name of your company.

Mailing Address

Enter your mailing address. Enter the street, box number, city, state, and ZIP code.

Mail to (if different than above address)

Enter the address where your or another person’s driving record must be sent, if different from your mailing address above.

Telephone Number

Enter your telephone number.

Mark the appropriate box or boxes for the driving record you want to obtain. Companies with bulk purchases must complete Form VG-118, Driver Privacy Protection Act Agreement.

Listings of 1 through 4 current or expired registrations — $8.00

Mark the box if you want to obtain listings of one through four current or expired registrations for $8.

Listings of 1 through 4 current or expired operator's license — $8.00

Mark the box if you want to obtain listings of one through four current or expired operator's licenses for $8.

Certified copy of current or original registration application — $8.00

Mark the box if you want to obtain a certified copy of your or another person's current or original registration application for $8.

Certified copy of expired operator’s license application — $8.00

Mark the box if you want to obtain a certified copy of your or another person's expired operator’s license application for $8.

Certified copy individual accident report — $12.00

Mark the box if you want to obtain a certified copy of your or another person's accident report for $12.

Certified copy police accident report — $18.00

Mark the box if you want to obtain a certified copy of your or another person's police accident report for $18.

Insurance information of accident — $8.00

Mark the box if you want to obtain your or another person's insurance information of accident for $8.

Statistics and research — $42.00 per hour

Mark the box if you want to obtain driving records for statistics and research for $42 per hour.

Periodic inspection sticker record — $8.00

Mark the box if you want to obtain your or another person's periodic inspection sticker record for $8.

List of registered dealers, transporters, periodic inspection stations, rental vehicle companies, fuel dealers and distributors (including gallons sold or delivered — $8.00 per page

Mark the box if you want to obtain a list of registered dealers, transporters, periodic inspection stations, rental vehicle companies, fuel dealers, and distributors for $8 per page.

Certified copy of suspension notice — $8.00

Mark the box if you want to obtain a certified copy of your or another person's suspension notice for $8.

Certified copy of reinstatement notice — $8.00

Mark the box if you want to obtain a certified copy of your or another person's reinstatement notice for $8.

Certified copy of title — $6.00

Mark the box if you want to obtain a certified copy of your or another person's vehicle title for $6.

Certified copy of vehicle title search, title info, lien info. — $22.00

Mark the box if you want to obtain a certified copy of your or another person's vehicle title search, title information, and lien information for $22.

Certified copy of vessel, snowmobile, or ATV title search — $13.00

Mark the box if you want to obtain a certified copy of your or another person's vessel, snowmobile, or all-terrain vehicle (ATV) title search for $13.

Certified copy of 3-year operating record (Vermont only) — $14.00

Mark the box if you want to obtain a certified copy of your or another person's 3-year operating record for $14.

Certified copy of complete operating record (Vermont only) — $20.00

Mark the box if you want to obtain a certified copy of your or another person's complete operating record for $20.

Other

Mark the box for other requests. Then, provide an explanation later. The minimum charge for other requests is $8.

I am requesting information concerning

"Another person" refers to the person you are requesting a driving record.

VIN

Enter your or another person's Vehicle Identification Number.

Vehicle Make

Enter the brand of your or another person's vehicle.

Vehicle Year

Enter the vehicle year of your or another person's vehicle.

VT License Plate #

Enter the Vermont license plate number of your or another person's vehicle.

Expiration Date

Enter the expiration date of your or another person's VT license plate number.

Name

Enter your or another person's name.

VT Driver License Number

Enter your or another person's Vermont driver's license number.

Date of Birth

Enter your or another person's birthdate.

Social Security Number

Enter your or another person's Social Security Number.

Street/Box Number

Enter the street address or P.O. box number where your or another person's vehicle is registered.

City

Enter the city where your or another person's vehicle is registered.

State

Enter the state where your or another person's vehicle is registered.

Zip Code

Enter the ZIP code where your or another person's vehicle is registered.

Date(s) you want covered, if applicable (does not apply to driving records)

If you are requesting your or another person's driving records, do not fill out this part.

Month, Day, Year

Enter the starting month, day, and year of the dates covered on the record you are requesting.

Through — Month, Day, Year

Enter the ending month, day, and year of the dates covered on the record you are requesting.

AUTHORIZATION OF RELEASE OF INFORMATION

If you are requesting another person's record, he or she must fill out this part. This part must also be filled out if you initial number 12 on the back page.

I hereby, with my signature, authorize (print name of person or business you are authorizing)

Enter the name of the person or business you authorize to release your information.

To perform a one-time search of the VT Department of Motor Vehicles files (pertaining to me) and any resulting reports

Mark the box if you authorize the person or business to perform a one-time search of the Vermont Department of Motor Vehicles (DMV) files of you and any resulting reports.

To perform a one-time authorization to transact business (pertaining to me) with the VT Department of Motor Vehicles

Mark the box if you authorize the person or business to perform a one-time authorization to transact business with the Vermont DMV.

Signature of individual authorizing release

Enter your signature.

Date authorization given

Enter the date you signed the Vermont Driving Record Request Form.

Information requested (be specific, if necessary use separate sheet of paper)

If you marked Other on the front page, fill out this part.

Provide additional information about your request.

You must initial inside the appropriate box(es)/category(ies) below:

The requestor must provide identification documents for all requests, including copies of any state-issued identification and documentation that he or she is authorized to obtain the requested information.

If you are unsure of what documents are required, contact 802-828-2000.

1. For use by any government agency, including any court or law enforcement agency, in carrying out its functions, or any private person acting on behalf of a government agency in carrying out its functions.

Enter your name initials if the information or record you request is for any government agency, including any court or law enforcement agency, in carrying out its functions, or any private person acting on behalf of a government agency in carrying out its functions. Then, provide identification documents. If not, leave it blank.

2. For use in connection with matters of motor vehicles 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.

Enter your name initials if the information or record you request is for use in connection with matters of motor vehicles 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. Then, provide a signed document containing the reason or reasons why you qualify under this category. If not, leave it blank.

3. For use in the formal course of business by a legitimate business or its agents, employees, or contractors:

a. To verify the accuracy of personal information submitted by the individual to the business or its agents, employees, or contractors; and

b. If the information as so submitted is not correct or 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.

Enter your name initials if the information or record you request is for use in the formal course of business by a legitimate business or its agents, employees, or contractors to verify the accuracy of personal information submitted by the individual to the business or its agents, employees, or contractors. If the information provided does not match DMV records, the correct information will not be provided. DMV will only disclose that information does not match. Then, provide identification documents. If not, leave it blank.

4. For use in connection with any 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 an order of any court.

Enter your name initials if the information or record you request is for use in connection with any 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 an order of any court. Then, provide a signed document containing the reason or reasons why you qualify under this category. If not, leave it blank.

5. For use in research activities, and for use in producing statistical reports, so long as the personal information is not published, re-disclosed, or used to contact individuals.

Enter your name initials if the information or record you request is for research activities and producing statistical reports, so long as the personal information is not published, re-disclosed, or used to contact individuals. Then, provide a signed document containing the reason or reasons why you qualify under this category. If not, leave it blank.

6. For use by any insurer or insurance support organization, or by a self-insured entity, or its agents, employees, or contractors, in connection with claims investigation activities, antifraud activities, rating, or underwriting. Appropriate documents identifying requester are required.

Enter your name initials if the information or record you request is for use by any insurer or insurance support organization or a self-insured entity or its agents, employees, or contractors in connection with claims investigation activities, antifraud activities, rating, or underwriting. Then, provide identification documents. If not, leave it blank.

7. For use in providing notice to the owner or lien-holder of a towed or impounded vehicle.

Enter your name initials if the information or record you request is for providing notice to the owner or lien-holder of a towed or impounded vehicle; otherwise, leave it blank.

8. For use by any licensed private investigative agency or licensed security service for any purpose permitted under this section.

Enter your name initials if the information or record you request is for use by any licensed private investigative agency or licensed security service for any purpose permitted under this section. Then, provide identification documents. If not, leave it blank.

9. For use by an employer, of its agent or insurer, to obtain or verify information relating to a holder of a commercial driver's license which is required under the Commercial Motor Vehicle Safety Act of 1996 [Title XII of Public Law 99-570].

Enter your name initials if the information or record you request is for the use of an employer or its agent or insurer to obtain or verify information relating to a holder of a commercial driver's license as required under the Commercial Motor Vehicle Safety Act of 1996. If not, leave it blank.

10. For use in connection with the operation of private toll transportation facilities.

Enter your name initials if the information or record you request is for use in connection with the operation of private toll transportation facilities; otherwise, leave it blank.

11. For any use specifically authorized by law that is related to the operation of a motor vehicle or public safety.

Enter your name initials if the information or record you request is for any use specifically authorized by law that is related to the operation of a motor vehicle or public safety. Then, provide a signed document containing the reason or reasons why you qualify under this category. If not, leave it blank.

12. Unrestricted or specified use with written consent of the person who is the subject of the information. This includes information regarding oneself. ("Release portion" on other side this form must be completed in full.)

Enter your name initials if the information or record you request is for unrestricted or specified use with written consent of the person who is the subject of the information. It includes information regarding oneself. Then, fill out the AUTHORIZATION OF RELEASE OF INFORMATION on the front page. If not, leave it blank.

Signature of Requester

Enter your signature.

Date

Enter the date you signed the Vermont Driving Record Request Form.

Driver License/Corporate Number of Requester

Enter your driver's license or corporate number.

What is the Driver's Privacy Protection Act?

The Driver's Privacy Protection Act is a law enacted to protect the privacy of personal information assembled by the State Department of Motor Vehicles. It states that disclosure of an individual's motor vehicle record is prohibited unless done with permission or authorization.

How to file the Vermont Driving Record Request Form?

Submit your Vermont Driving Record Request Form, payment, and other required documents to:

Vermont DMV

120 State Street

Montpelier, Vermont 05603-0001

Do not mail cash for your payment. Make check or money order payable to Vermont Department of Motor Vehicles.