Form Dl 503 PDF Details

Form DL 503 is a document used by the California Franchise Tax Board to determine the amount of tax owed by a taxpayer. This form can be filled out online or through the mail, and must be completed by all individuals and businesses with taxable income in California. There are a number of factors that are taken into account when calculating taxes owed, so it is important to understand how to correctly complete this form. You can find more information on the FTB website, or consult with an accountant or tax specialist.

QuestionAnswer
Form NameForm Dl 503
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform driver information, pa penndot request form, pa form request driver, pa request driver

Form Preview Example

DL-503 (7-11)

REQUEST FOR DRIVER INFORMATION

The most current version of this form can be found at www.dmv.state.pa.us

PLEASE TYPE OR PRINT IN BLUE OR BLACK INK

DO NOT SEND CASH • See reverSe for inStruCtionS

D E PA R T M E N T O F T R A N S P O R TAT I O N

Bureau of Driver Licensing

P.O. Box 68695

Harrisburg, PA 17106-8695

cHEcK (✔) oNE oNLy:

❑bASIc INFoRMATIoN: $5.00 FEE (Driver history is not included)

❑3 yEAR DRIvER REcoRD: $5.00 FEE

❑10 yEAR DRIvER REcoRD: $5.00 FEE (Employment Purposes Only)

❑FuLL HISToRy: $5.00 FEE

❑cERTIFIED DRIvER REcoRD: $10.00 FEE

❑copy oF DocuMENT FRoM FILE (MIcRoFILM): $5.00 FEE

❑cERTIFIED copy oF DocuMENT FRoM FILE: $10.00 FEE

You may obtain a copy of your own 3 year, 10 year and/or Full History Driving Record on PennDOT'S website at www.dmv.state.pa.us

 

A

REQUESTER INFORMATION

 

 

 

B

 

END USER OF INFORMATION BEINg REQUESTED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME/coMpANy

 

 

 

 

 

 

NAME/coMpANy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

ADDRESS (P.O. Box not acceptable), need to provide physical location of business/residence

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

cITy

 

 

 

 

 

STATE

ZIp coDE

cITy

 

STATE

ZIp coDE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DAyTIME TELEpHoNE NuMbER (required)

 

 

 

DAyTIME TELEpHoNE NuMbER (required)

 

 

 

 

 

 

RELATIoNSHIp To DRIvER (required)

 

 

 

RELATIoNSHIp To DRIvER (required)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

 

AFFIDAVIT OF INTENDED USE

 

 

 

 

 

 

 

 

 

 

X

 

 

 

 

 

 

Intended use of the Information Requested: CHECK ONLY ONE

 

 

 

 

 

SIGNATURE

 

 

 

 

 

 

 

 

 

❏ B = Driver Release (Driver must complete Section E.)

 

 

 

 

 

 

 

NOTARIZATION NOT REQUIRED WHEN REQUESTING YOUR OWN RECORD

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ C = Credit Business (Legitimate Business need in connection with a business

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

DRIVER INFORMATION

 

 

 

 

 

 

 

 

transaction initiated by the driver.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ C = Credit Potential Investor, Server or Current Insurer (In connection

 

 

NAME:

LAST

 

FIRST

INITIAL

 

 

 

 

 

 

 

 

 

with an assessment of the credit/payment risks associated with an existing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

credit obligation.)

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

❏ E = Employment (To support the hiring or the continuation of employment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver must complete Section E.)

 

 

 

 

 

 

cITy

 

 

 

 

 

 

 

 

 

 

 

 

❏ R=Insurance Company requesting record of person it intends to insure,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

now insures, or has rejected for insurance.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ K = Court Order must be attached. (A subpoena issued in compliance

 

 

STATE

 

 

 

 

 

 

ZIp coDE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

with Pa. R.C.P. 4009.21 will be accepted in lieu of a court order).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ L = Attorney representing driver identified

in Section c (Driver must

 

 

pHoNE NuMbER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

complete Section E.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I hereby certify that_______________________________________________

 

 

 

 

DATE oF bIRTH

DRIvER NuMbER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

pRINTED NAME oF REQuESTER

 

 

 

 

 

MoNTH

DAy

 

yEAR

 

 

 

 

 

will use the driver record abstract(s) required pursuant to Section 6114

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of the Pennsylvania Vehicle Code, for the purpose checked above only

 

E

DRIVER RELEASE

 

 

 

 

 

and no other reason. This affidavit is filed in compliance with Section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

607 of the Fair Credit Reporting Act. I/We have read and signed this

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I _______________________________________ hereby request

form after its completion, and I/We swear or affirm that the statements

 

 

made herein are true and correct, and that any statement made on or

 

 

 

 

 

 

 

 

NAME oF DRIvER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

pursuant to this form is subject to the penalties of 18 Pa C.S. Section

 

 

the Department of Transportation to furnish a copy of my pA Driver's

 

 

Record to____________________________________________

4903(a)(2) (relating to false swearing), which shall include punishment

 

 

of a fine not exceeding $5,000, or to a term of imprisonment of not more

 

 

 

 

 

 

 

 

 

NAME oF pERSoN/coMpANy

 

 

 

 

 

 

X

 

 

 

 

 

 

 

 

 

than two years, or both.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

X

 

 

 

 

 

 

 

 

 

SIGNATuRE oF DRIvER

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

_______________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATuRE oF REQuESTER

 

 

 

 

 

F

MICROFILM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title ___________________________________________________________

 

 

TypE oF DocuMENT

 

DATE oF vIoLATIoN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SubScRIbED AND SWoRN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To bEFoRE ME:

MoNTH

DAy

yEAR

 

 

(see list of available documents below)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTARIZATION

 

 

 

X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Documents Available:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATuRE oF pERSoN ADMINISTERING oATH

 

 

 

 

 

 

 

• Citations

 

• Suspension Credit Affidavits

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

• Court Certifications

• Suspension/Revocation Letters

 

 

 

 

S

 

 

 

 

 

 

 

 

 

 

• Applications

 

• Restoration Letters

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

• License Renewals

• Rescind Letters

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

• Judgments

 

• Department Hearing or Exam Notice

 

 

 

 

A

 

SIgN IN PRESENCE OF NOTARY

 

 

 

 

 

MESSENgER NO.

 

 

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DL-503 (7-11)

INSTRUCTIONS

1.To request your own record, complete Sections A & C only. Notarization is NOT required.

2.To request a record other than your own, complete Sections A, C, and D. Section E must contain the driver's signature if block

B, E or L is checked in Section D. If the Requester is obtaining the information on behalf of someone else, Section B must also be completed.

3.PRINT OR TYPE all requested information on the front of the form. Submitting ONLY a name and address does not provide enough information for a proper search of the driver files.

4.A non-refundable fee is required for each request. If the Bureau has no record for the information requested or the data supplied is insufficient, the fee will be applied to the cost of the search.

5.If requesting a microfilm copy of a document, also complete Section F. You must be specific in providing the type and date of the document. If there are several citations on the record, the cost is $5.00 per citation. You need to provide the date of the violation/action to clearly identify the citation(s) requested.

6.Check the type of record requested at the top of the form and make check or money order payable to "PennDOT." DO NOT SEND CASH. Attach your check or money order and send to:

 

For overnight and other special mail:

buREAu oF DRIvER LIcENSING

buREAu oF DRIvER LIcENSING

DRIvER REcoRD SERvIcES

DRIvER REcoRD SERvIcES

P.O. BOx 68695

1101 SOuTH FRONT STREET 3RD FLOOR

HARRISBuRg, PA 17106-8695

HARRISBuRg PA 17104-2516

 

DESCRIPTION OF INFORMATION AVAILABLE

bASIc INFoRMATIoN

Includes name, address, driver number, date of birth and class of license.

($5.00 fee)

 

3 yEAR REcoRD*

Includes name, address, driver number, date of birth, class, license status, Departmental actions and violations for the

($5.00 fee)

past 3 years from the date request is processed. You can obtain a copy of your own record on PennDOT's website at

www.dmv.state.pa.us

 

10 yEAR REcoRD*

Includes name, address, driver number, date of birth, class, license status, Departmental actions and violations for the

($5.00 fee)

past 10 years from the date request is processed. A 10-year record is for employment purposes only. You can obtain a

 

copy of your own record on PennDOT's website at www.dmv.state.pa.us

FULL HISTORY �������������������

Includes name, address, driver number, date of birth, class, license status, Departmental actions and violations for the

($5.00 fee)

complete history of the driver on file in Pennsylvania�

 

cERTIFIED REcoRD

Includes name, address, driver number, date of birth, class, license status, Departmental actions and violations for the

($10.00 fee)

complete history of the driver on file in Pennsylvania certified by the Department.

MIcRoFILM

 

DocuMENT

Copies of documents retained by the Department are available for purchase from the microfilm file. You must be specific

($5.00 fee)

as to the type of document and the date of the violation/action.

cERTIFIED copy

 

oF DocuMENT

Copies of documents from the microfilm file that have been certified by the Department.

($10.00 fee)

 

IMPORTANT INFORMATION CONCERNINg THE USE OF DRIVER INFORMATION

•Driver record information is confidential and restricted information and the Requestor/End user is responsible for establishing procedures to protect the confidentiality of these records.

•Driver record information can only be used for the purpose stated in Section D.

•Driver record information cannot be sold, assigned, or otherwise transferred to any party, other than the End user.

•PennDOT retains exclusive ownership of all driver record information and the Requestor/End user shall not combine and/or link in with any other data on any database except as may be required by law.

•The driver record information cannot be used for direct mail advertising or any other type or types of mail or mailings.

•The driver record information cannot be disseminated or published on the Internet without the express written permission of pennDoT.

•PennDOT reserves the right to audit each request for driver record information. If the Requestor/End user is found to have requested driver record information for an unauthorized purpose, access to Pennsylvania driver record information will be terminated.

*Businesses who obtain driver records for the purpose of employment or insurance are now able to obtain and print these records, in real time, through our enhanced Online Services.

If you are an employer or insurance company/agent and are interested in becoming an authorized Online business user, please visit our website at www.dmv.state.pa.us and click on "Online Business Services" for more information.

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Step number 1 of filling in pa dl 503

2. Soon after this section is filled out, go to type in the applicable information in all these: ADDRESS, CITY, STATE, PHONE NUMBER, C Credit Potential Investor, E Employment To support the, ZIP CODE, must complete Section E, R Insurance Company requesting, insure now insures or has rejected, K Court Order must be attached A, Pa RCP will be accepted in lieu, L Attorney representing driver, complete Section E, and DATE OF BIRTH.

pa dl 503 completion process detailed (stage 2)

Always be really careful when completing K Court Order must be attached A and must complete Section E, since this is the section where a lot of people make a few mistakes.

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