Dr 057 Mva Form PDF Details

Accessing and understanding motor vehicle records is essential for a variety of legal, personal, and professional reasons. Among the forms designed for this purpose, the DR-057 MVA form stands out as a critical tool in the state of Maryland. It serves as a request for motor vehicle administration records, offering options for both certified and non-certified records at distinct price points. This document allows for the retrieval of comprehensive vehicle information, including tag number, VIN, and details related to the make and model of the vehicle. Additionally, it provides for the acquisition of driver records, which is especially pertinent for holders of commercial driver's licenses (CDLs) seeking to obtain their medical certification information. The form necessitates detailed input from the requester, encompassing personal identification, addressee information for mailing, and the specific type of record being sought. Its design accommodates a variety of requestors, including the individual of record, their attorney, law enforcement agencies, and employers of CDL drivers, among others. The provisions of the DR-057 form emphasize stringent adherence to confidentiality and legal compliance, outlining obligations for the requester regarding the use, disclosure, and retention of the obtained information in alignment with both federal and state laws. Such meticulous regulations underscore the balance between accessibility of information and protection of privacy within the framework of motor vehicle administration records requests.

QuestionAnswer
Form NameDr 057 Mva Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmaryland dmv form dr 057, mva maryland requestor, mva from request online, md mva mvr

Form Preview Example

DR-057 (02-19)

Request for Motor Vehicle Administration Records

Please complete all requested information as applicable.

Certified Record: $12.00

Non-Certified Record: $9.00

Subject of Record:

rVehicle Record Tag No.:

VIN:

Yr./Make/Model:

rDriver Record

CDL holders: To obtain your medical certification information, you must

also request a PBJ driving record.

Name:

DOB:

LIC #:

Address:

Please complete this section if record is to be mailed. Please print or type information.

Full Name:

Street Address:

City:

State:

Zip Code:

Type of Record:

r3 year driving record

r*Complete driving record (all information in MVA data base).

r*PBJ driving record (Also contains medical certification

information for CDL holders)

*Available to: individual of record or individual’s attorney; police or judicial system; authorized representative of any federal, state or local govern- ment; or authorized employer of CDL drivers.

rApplication for driver’s record/identification card.

rTitle record.

rCertified copy of Maryland title for export of vehicle.

rRegistration record.

rOriginal issue date of license.

rOther:

Requestor Information:

Name:

LIC #:

Address (Home):

Telephone (Home):

Address (Work):

Telephone (Work):

Identification (MVA Use Only):

Type of Identification Accepted:

LIC #:

Other Number:

Verified By:

Status:

r Attorney (Please sign “Attorney Certification” if requesting complete

driving record of your client)

“I certify that I am the attorney for the individual whose complete driving record or PBJ is being requested.”

Attorney’s Signature:

rEmployer:

“I certify that I am an employer or potential employer of the individual for whom I am requesting/receiving a driving record, and that a valid commercial driver’s license is required of the individual as a condition of employment.”

Employer’s Signature:

Printed Name:

Purpose of Request:

rBusiness Name:

rLaw Enforcement/Government Agency

Name:

rInsurance Company

Name:

rResearcher:

rOwn record:

rOther: Please specify:

My signature acknowledges, under penalty of criminal prosecution, that I will use information received from the Motor Vehicle Administration (MVA) solely for the purpose I describe on this application, and further agree that I will not release personal information obtained from MVA records except as permitted by Title 4 of the General Provisions Article (Maryland Public Information Act).

I understand and acknowledge that by requesting information from Motor Vehicle Administration records I have read and agree to the terms of the MVA Privacy Protection Agreement on the reverse side of this form. I also acknowledge that I have read the Notice of Appeal Procedure also set forth on the reverse side.

Signature: _________________________________________ Printed name: ______________________________________ Date: _______________________

MVA Use Only: Certified Non-Certified Cash Check Credit Card Gratis

6601 Ritchie Highway, N.E., Glen Burnie, Maryland 21062

For more information visit our website at www.mva.maryland.gov, call 410-768-7000 or TTY for the hearing impaired: 1-800-492-4575.

Part 1 - Accounting Copy

Part 2 - Office Copy

Part 3 - Customer Copy

MVA Privacy Protection Agreement

Use of information obtained through this Request is governed by Federal and State laws. It is the responsibility of the Requestor to insure that all use of information obtained through this Request complies with all applicable Federal and State laws.

By signing this “Request for Motor Vehicle Records”, the Requestor certifies that the Requestor, (if applicable) Requestor’s employer and employees:

1.Understand that federal laws affect access to and use of computer information, including, but not limited to, 15 U.S.C. § 271

et seq. (National Institute of Standards and Technology); 44 U.S.C. § 3541 et seq. (Federal Information Security Management Act of 2002); 49 U.S.C. § 30301 et seq. (National Driver Register Act of 1982); 5 U.S.C. § 552 (Freedom of Information Act);

5 U.S.C. § 552a (Privacy Act of 1974); 18 U.S.C. § 1030 (U.S. Computer Crime Statute of 1984); 18 U.S.C. § 1001 et seq. (Computer Fraud and Abuse Act of 1986); 17 U.S.C. § 109 (Computer Software Rental Amendments Act of 1990); 15 U.S.C. § 1681 et seq. (Fair Credit Reporting Act); and 18 U.S.C. § 2721 et seq. (Driver’s Privacy Protection Act of 1994).

2.Understand that the Maryland Department of Transportation Office of Transportation Technology Services, its client agencies and their customers also adhere to State data processing security policies as set forth in Executive Order 01.01.1983.18 (Privacy and State Data System Security); Md. Code Ann., Criminal Law Article § 8-606 (Making false entries in public records and related crimes) and § 7-302 (Unauthorized access to computers and related material); Md. Code Ann., General Provisions Article, Title 4 (Maryland Public Information Act); and, as published by the Secretary of the Department of Budget and Management from time to time under Md. Code Ann., State Finance and Procurement Article, Title 3A, Subtitle 3 (Information Processing).

3.Agree to maintain in strictest confidence and not unlawfully disclose to any person, firm, or corporation information obtained as a result of their access to personal information from motor vehicle records.

4.Are familiar with all provisions of the federal Driver’s Privacy Protection Act of 1994, 18 U.S.C. § 2721 et seq., and with Title 4 of the General Provisions Article (Maryland Public Information Act), and §§ 12-111 through 12-113 of the Transportation Article, Annotated Code of Maryland, which limit access to personal information from public records in Maryland. The Requestor on behalf of itself, its successors and assigns further agrees that all users will abide by the terms of both the federal and state law including, but not limited to, those restricting access to personal information from Motor Vehicle Administration records only to those persons and for those purposes which are permitted under both laws.

5.Agree to keep a record for five (5) years of persons to whom personal information is redisclosed under this Agreement, and the purpose for which the personal information is to be used; and, to make that record available to the Motor Vehicle Administration upon request.

6.Shall be liable for, and shall indemnify, defend and hold the Motor Vehicle Administration harmless for any misuse or misappropriation of any personal information in a record obtained from the Administration in connection with this Agreement, including, without limitation, reasonable attorneys’ fees and all other costs of litigation.

7.Shall further indemnify the Motor Vehicle Administration for and against any and all losses, damages, judgments, liabilities, or similar costs and expenses which arise in whole or part out of acts or omissions by the client with respect to laws restricting access to and disclosure of vehicle records including, without limitation, reasonable attorneys’ fees and all other costs of defending against such action or claim.

Notice of Appeal Procedure

In accordance with General Provisions Article (“GP”) § 4-203(c), the Requestor (“You” or “you”) is informed of all available remedies for review of the decision of the Motor Vehicle Administration (“MVA”) to withhold any of the documents requested on the front side of this form. You have the right/option to refer your concerns to the Public Access Ombudsman, in the Office of the Attorney

General, pursuant to GP § 4-1B-01, et. seq. You may also pursue judicial enforcement under GP § 4-362 of the Maryland Public Information Act. (Copies of the law available upon request.)

Reverse

Apply to...

Apply to register to vote with your driver’s license transaction. For details ask your customer agent.

to Vote Now!

How to Edit Dr 057 Mva Form Online for Free

In case you need to fill out md mva driving record, you won't have to download and install any kind of software - just try our PDF editor. Our team is committed to giving you the absolute best experience with our editor by continuously adding new capabilities and improvements. With these updates, working with our tool becomes easier than ever before! Here is what you'll want to do to begin:

Step 1: Hit the "Get Form" button above on this page to open our PDF editor.

Step 2: Using our advanced PDF tool, you're able to do more than just fill out blank form fields. Express yourself and make your forms appear great with custom text put in, or modify the file's original input to excellence - all that backed up by the capability to incorporate your own photos and sign the PDF off.

This document requires some specific information; to guarantee correctness, don't hesitate to adhere to the next steps:

1. You need to complete the md mva driving record properly, so be mindful while filling in the parts containing these blanks:

Completing section 1 of mva request online

2. Once this section is completed, go to type in the suitable details in these: Status r Attorney Please sign, driving record of your client, r Business Name, r Law EnforcementGovernment Agency, I certify that I am the attorney, Name, Attorneys Signature r Employer I, Employers Signature, Printed Name, Purpose of Request, r Insurance Company, Name, r Researcher, r Own record, and r Other Please specify.

Step no. 2 of filling out mva request online

Always be very careful when filling out Attorneys Signature r Employer I and I certify that I am the attorney, as this is where many people make a few mistakes.

Step 3: Always make sure that the information is accurate and then just click "Done" to finish the project. Create a free trial subscription at FormsPal and gain instant access to md mva driving record - download or edit inside your personal account page. FormsPal guarantees your information confidentiality with a protected system that in no way saves or shares any kind of sensitive information typed in. Feel safe knowing your docs are kept protected every time you use our editor!