Gaining access to information held by the Department of Motor Vehicles (DMV) requires a formal process, which is facilitated by the DMV CRD 93 form. This document is the gateway for individuals, organizations, and legal entities to request records varying from driving history to vehicle details. Its structure ensures clarity and legality in the communication between the requester and the DMV, emphasizing the importance of data privacy and the stringent regulations surrounding the access to such information. From driving record information, which includes license history and conviction data, to vehicle information detailing description and registration data, the form serves multiple purposes including requests for police crash reports and decedent photo requests. Additionally, it outlines the necessity for specific authorizations for certain types of requests, such as an employer needing authorization from an individual to access their driving record, ensuring that the process respects privacy laws and individual rights. Furthermore, the form requires a certification by the requester, affirming the lawful use of the information requested and acknowledging the potential legal repercussions of misuse. The careful design of the form reflects a balance between the need for information for legitimate purposes and the imperative to protect individuals’ privacy as mandated by both state and federal laws.
| Question | Answer |
|---|---|
| Form Name | Dmv Form Crd 93 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | virginia dmv form crd93, virginia dmv crd 93, form crd93 va dmv, crd93 |
INFORMATION REQUEST
CRD 93 (07/01/2013)
Purpose: Use this form to request information from DMV records.
Instructions: Type or print clearly.
REQUESTER INFORMATION
REQUESTER FULL NAME (last, first, mi, suffix) |
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FEDERAL TAX ID OR SOCIAL SECURITY NUMBER* |
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ORGANIZATIONAL AFFILIATION (if any) |
TELEPHONE NUMBER |
USE AGREEMENT NUMBER (if applicable) |
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STREET ADDRESS |
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ACCESS CODE (if applicable) |
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CITY |
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STATE |
ZIP CODE |
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REASON FOR REQUEST (be specific) |
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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), otherwise you do not need to complete this section.
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)
SUBJECT DRIVER LICENSE NUMBER
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SUBJECT BIRTH DATE (mm/dd/yyyy)
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
Check one or more boxes to indicate your involvement in the crash: |
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I was a DRIVER |
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I was a PASSENGER |
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I am a VEHICLE OWNER |
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I am the OWNER of property involved in the accident |
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I legally REPRESENT an involved person |
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I was injured |
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OTHER (explain) |
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I was NOT involved in the accident AND I do not legally represent an involved person |
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I am an authorized representative of any insurance carrier reasonably anticipating exposure to civil liability as a consequence of the accident or to which the person has applied for issuance or renewal of a policy of automobile insurance
IMPORTANT NOTE: The Department may only release a full accident report to a person involved in the accident, or their legal or personal representative, in accordance with Virginia Code §
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
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PASSENGER/PEDESTRIAN FULL NAME (last, first, mi, suffix) |
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PASSENGER/PEDESTRIAN FULL NAME (last, first, mi, suffix) |
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PASSENGER/PEDESTRIAN FULL NAME (last, first, mi, suffix) |
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PASSENGER/PEDESTRIAN FULL NAME (last, first, mi, suffix) |
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* Required by the State Comptroller for debt
Continues on Reverse Side
CRD 93 (07/01/2013)
INFORMATION REQUESTED (continued)
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): |
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Spouse |
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Executor |
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Child |
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Administrator |
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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.
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.
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 §
REQUESTER SIGNATURE
DATE (mm/dd/yyyy)
OTHER INFORMATION (Be specific)
DMV CUSTOMER SERVICE CENTER USE ONLY
Proof of Requester's Identification |
Proof of Requester's Organization Affiliation |
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Valid Driver's License Number ______________________ |
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Request on Organization Letterhead Stationery |
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Business Card from Organization |
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Law Enforcement Badge Number ________________ |
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Other Photo Identification _________________________ |
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Other _________________________________ |
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If referred to Headquarters to Fill Request, Complete: |
Remarks/CSR Stamp |
Fee Charged |
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CSR Name __________________________________________ |
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$ |
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CSC Name (not CSC number) ___________________________ |
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