Crd93 Form Online PDF Details

In our digitally-driven world, accessing information is more crucial than ever, especially when it comes to personal and public safety. The Crd93 form serves as a vital tool in this endeavor, specifically designed to facilitate the retrieval of various types of information from DMV records. This form is not just a simple request paper; it embodies the intersection of privacy, legal authority, and the public’s right to know. It caters to individuals and entities looking to obtain driving records, vehicle details, or even police crash reports, among other data. With clearly outlined instructions, the form mandates requesters to provide detailed personal information, ensuring a secure and purposeful exchange of information. It is predicated upon stringent legal frameworks such as the Virginia Code and Federal Drivers Privacy Protection Act, underscoring the importance of lawful use and the severe repercussions of misuse. This form is not only a gateway to crucial data for legal, insurance, employment, or personal purposes but also a testament to the delicate balance between transparency and privacy protection in the digital age.

QuestionAnswer
Form NameCrd93 Form Online
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescrd 93, crd 93 form, va crd 93, crd93 form

Form Preview Example

INFORMATION REQUEST

CRD 93 (07/01/2021)

 

Purpose: Use this form to request information from DMV records.

Instructions: Type or print clearly.

REQUESTER INFORMATION

REQUESTER FULL NAME (last, first, mi, suffix)

 

 

 

 

 

FEDERAL TAX ID OR SOCIAL SECURITY NUMBER*

 

 

 

 

 

 

 

 

EMAIL ADDRESS

 

ORGANIZATIONAL AFFILIATION (if any)

TELEPHONE NUMBER

USE AGREEMENT NUMBER (if applicable)

 

 

 

 

 

(

)

 

 

STREET ADDRESS

 

 

CITY

 

 

 

 

 

 

 

 

 

 

STATE

ZIP CODE

ACCESS CODE (if applicable)

TNC CERTIFICATE NUMBER (if applicable)

 

 

 

 

 

 

 

 

 

 

REASON FOR REQUEST (be specific) (attach additional sheets if necessary)

 

 

 

 

 

*In accordance with Virginia Code §§2.2-803, 2.2-4807, and 58.1-520 et seq., the State Comptroller requires that the information requested on this application, including your social security number, be collected for debt set off collection purposes.

GOVERNMENT REQUESTER

IDENTIFY PROPOSED USE AND LEGAL AUTHORITY (Attach additional pages if needed. Attach letter with case information)

 

Federal

 

State

 

City

 

County

 

Special District

 

Other (identify below)

 

 

 

 

 

 

IF OTHER, IDENTIFY TYPE

Check here if you are an attorney for the Commonwealth requesting information pursuant to your authority under Va. Code § 15.2-1627.

Check here if you are a public defender requesting information pursuant to your authority under Va. Code § 19.2-163.3.

CASE DATE

SUBJECT INFORMATION

If you are requesting driving record information, the subject will be the person you are requesting information on. If you are requesting vehicle information, the subject will be the vehicle owner (if available).

SUBJECT FULL NAME (last, first, mi, suffix)

CHECK TO INDICATE SUBJECT NAME AND ADDRESS IS THE SAME AS THE REQUESTER ABOVE.

STREET ADDRESS

CITY

STATE

ZIP CODE

INFORMATION REQUESTED

Check one or more boxes below to indicate the type of information you wish to receive. All data fields must be completed for Driving Record Information, Vehicle Information and Decedent Photo Requests. For Police Crash Reports provide as much information as possible.

DRIVING RECORD INFORMATION (Includes license history and conviction data) (complete SUBJECT INFORMATION above)

 

or

 

SUBJECT DRIVER LICENSE NUMBER

SUBJECT BIRTH DATE (mm/dd/yyyy)

REASON FOR REQUEST (Check one) Insurance Employment, School, or Military Member/Applicant/Volunteer Personal Use, Court, or Attorney TNC

An authorization from the subject is required for employers and others not authorized by Virginia code. I authorize the Department of Motor Vehicles to furnish, for this one time only, information pertaining to my driving record to the requester identified above.

SUBJECT SIGNATURE

DATE (mm/dd/yyyy)

VEHICLE INFORMATION (Includes vehicle description and registration data) (complete SUBJECT INFORMATION above)

 

VEHICLE IDENTIFICATION NUMBER (VIN)

VEHICLE MAKE

VEHICLE YEAR

 

 

 

 

POLICE CRASH REPORT

IMPORTANT NOTE: The Department may only release a full crash report in accordance with VA Code § 46.2-380.

Check one or more boxes to indicate your involvement in the crash:

I was a DRIVER.

I legally REPRESENT a person injured or involved in the crash.

I am the parent or legal guardian of a minor injured or killed in the crash.

I was a PASSENGER.

I was injured in the crash or as a result thereof (ex: injured pedestrian). I am the owner of a vehicle/property involved in the crash.

I am the personal representative (guardian, executor, next of kin, etc.) of a person injured or killed in the crash.

I am an authorized representative of any insurance carrier reasonably anticipating exposure to civil liability as a consequence of the crash or to which a person has applied for issuance or renewal of a policy of automobile insurance.

 

 

 

 

 

 

 

 

 

 

 

 

 

CRD 93 (07/01/2021)

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 2

 

 

 

 

 

 

 

INFORMATION REQUESTED (continued)

 

 

 

 

 

 

 

 

CRASH DATE (mm/dd/yyyy)

TIME OF CRASH

CRASH LOCATION (highway or street name)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY/COUNTY/TOWN WHERE CRASH OCCURRED

DRIVER FULL NAME (last, first, mi, suffix)

 

DRIVER LICENSE NUMBER

 

 

 

 

 

 

 

 

1.

PASSENGER/PEDESTRIAN FULL NAME (last, first, mi, suffix)

2.

PASSENGER/PEDESTRIAN FULL NAME (last, first, mi, suffix)

 

 

 

 

 

 

 

 

3.

PASSENGER/PEDESTRIAN FULL NAME (last, first, mi, suffix)

4.

PASSENGER/PEDESTRIAN FULL NAME (last, first, mi, suffix)

 

 

 

 

 

 

 

 

DECEDENT PHOTO REQUEST (requester may need to provide proof of death, i.e. copy of death certificate, executor papers, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DECEDENT FULL NAME (last, first, mi, suffix)

 

 

 

DECEDENT DMV CUSTOMER NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DECEDENT BIRTH DATE (mm/dd/yyyy)

 

Requester's relationship to decedent (check one):

 

 

 

Executor

 

 

 

 

 

 

 

 

 

 

Administrator

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER INFORMATION (Be specific)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CERTIFICATION

I understand that it is unlawful to use information provided by DMV for any purpose other than the one stated. I certify that the information I have requested with this form will be used only for the stated purpose and that any personal information I receive will not be used for the predominant purpose of solicitation of prospective clients.

I agree that the information I obtain in response to my request is considered privileged and confidential. I agree that such information is subject to the restrictions upon use and dissemination imposed by (1) the Federal Drivers Privacy Protection Act (18 USC § 2721 et seq.), (2) the Government Data Collection and Dissemination Practices Act (Va. Code § 2.2-3800 et seq.), (3) the provisions of Va. Code §§ 46.2-208 through 210, 46.2.212, and 58.1-3, and (4) any successor rules, regulations, or guidelines adopted by DMV with regard to disclosure or dissemination of any information obtained from DMV records or files, and I agree to comply with such restrictions and understand that any violation may result in damages, civil penalties, criminal penalties or other relief permitted pursuant to Virginia law. If representing a government entity, I agree that the information obtained will not be used for civil immigration purposes or knowingly disseminated to any third party for any purpose related to civil immigration enforcement. Distribution of privileged information, as described at Va. Code § 46.2-208, to any third party is prohibited unless specifically identified and agreed to by DMV.

For volunteer organizations identified in Va. Code § 46.2-208(B), I also certify that the subject of the information being requested is a member of, applicant for membership in or applicant to be a volunteer with my organization.

I further certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury, and I understand that knowingly making a false statement or representation on this form is a criminal violation.

REQUESTER SIGNATURE

DATE (mm/dd/yyyy)

 

 

CUSTOMER RECORDS FEES

Driving Record

$9.00

Supporting Documents (per page)

$3.00

Vehicle Record

$9.00

Motor Carrier Overweight Citation Record

$8.00

Police Crash Report

$8.00

Travel Emergency Photo Verification

$9.00

Decedent Photo

$9.00

Record Certification Fee (additional)

$5.00

Driver/Vehicle Application

$9.00

 

 

PAYMENT METHODS

If you are mailing this request, DMV can only accept check or money order via mail.

 

 

CHECK

ENTER CHECK AMOUNT

MONEY ORDER

ENTER MONEY ORDER AMOUNT

 

 

 

 

Made payable to DMV

 

Made payable to DMV

 

 

 

 

 

 

 

 

 

 

 

DMV CUSTOMER SERVICE CENTER USE ONLY

Proof of Requester's Identification

Valid Driver's License Number ______________________

Other Photo Identification _________________________

 

 

 

If referred to Headquarters to Fill Request, Complete:

Remarks/CSR Stamp

Fee Charged

CSR Name __________________________________________

 

$

CSC Name (not CSC number) ___________________________

 

 

 

 

 

 

How to Edit Crd93 Form Online Online for Free

It is easy to fill out documents taking advantage of our PDF editor. Updating the crd93 form is simple in the event you try out the following actions:

Step 1: Click the button "Get Form Here".

Step 2: So you are on the form editing page. You may modify and add information to the form, highlight words and phrases, cross or check specific words, add images, put a signature on it, delete unrequired fields, or eliminate them completely.

The following segments will compose the PDF form that you'll be creating:

va crd 93 blanks to fill in

The system will need you to prepare the Federal, State, City, County, Special District, Other identify below, IF OTHER IDENTIFY TYPE, Check here if you are an attorney, CASE DATE, Check here if you are a public, If you are requesting driving, SUBJECT FULL NAME last first mi, CHECK TO INDICATE SUBJECT NAME AND, SUBJECT INFORMATION, and STREET ADDRESS section.

part 2 to completing va crd 93

You will have to write particular particulars in the field An authorization from the subject, DATE mmddyyyy, VEHICLE INFORMATION Includes, VEHICLE MAKE, VEHICLE YEAR, POLICE CRASH REPORT IMPORTANT NOTE, Check one or more boxes to, I was a DRIVER, I was a PASSENGER, I legally REPRESENT a person, I was injured in the crash or as a, I am the parent or legal guardian, I am the owner of a, I am the personal representative, and I am an authorized representative.

va crd 93 An authorization from the subject, DATE mmddyyyy, VEHICLE INFORMATION Includes, VEHICLE MAKE, VEHICLE YEAR, POLICE CRASH REPORT IMPORTANT NOTE, Check one or more boxes to, I was a DRIVER, I was a PASSENGER, I legally REPRESENT a person, I was injured in the crash or as a, I am the parent or legal guardian, I am the owner of a, I am the personal representative, and I am an authorized representative blanks to fill

The CRD, CRASH DATE mmddyyyy TIME OF CRASH, INFORMATION REQUESTED continued, CITYCOUNTYTOWN WHERE CRASH, DRIVER LICENSE NUMBER, PASSENGERPEDESTRIAN FULL NAME last, PASSENGERPEDESTRIAN FULL NAME last, PASSENGERPEDESTRIAN FULL NAME last, PASSENGERPEDESTRIAN FULL NAME last, DECEDENT PHOTO REQUEST requester, DECEDENT FULL NAME last first mi, DECEDENT DMV CUSTOMER NUMBER, DECEDENT BIRTH DATE mmddyyyy, Requesters relationship to, and Executor Administrator area is the place where all sides can place their rights and responsibilities.

Filling in va crd 93 step 4

Check the sections CERTIFICATION I understand that it, REQUESTER SIGNATURE, DATE mmddyyyy, CUSTOMER RECORDS FEES, Driving Record Vehicle Record, Supporting Documents per page, PAYMENT METHODS If you are mailing, CHECK Made payable to DMV, ENTER CHECK AMOUNT, MONEY ORDER Made payable to DMV, ENTER MONEY ORDER AMOUNT, Proof of Requesters Identification, DMV CUSTOMER SERVICE CENTER USE, Valid Drivers License Number, and Other Photo Identification and then fill them out.

Finishing va crd 93 stage 5

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