Form DLD60 is an application that is used to request a duplicate driver license or ID card. This form can be used if your driver license or ID card has been lost, stolen, or damaged. If you would like a copy of your driving record, you can also use this form. In order to complete the form, you will need to provide your name, date of birth, social security number, and current address. You will also need to choose which type of document you would like to receive: a driver license/ID card or driving record. There is a $13 fee for each request. Once you have completed the form, you can mail it in or bring it to your local DMV office.
| Question | Answer |
|---|---|
| Form Name | Form Dld60 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Utah, disclosing, MVR, requesters |
REQUEST FOR MVR BASED ON
PERMISSIBLE USE #13 OF THE DPPA
This form shall be used by persons making requests for a driver record (MVR - Motor Vehicle Report) under U.C.A. 53-
PERSON REQUESTING THE MVR
Please type or print all information.
Name of Requester _________________________________ Daytime telephone _________________________
Name of Company (if applicable) _______________________________ Date of request __________________
Mailing Address ________________________________________________________________________________
(Street) |
City/State |
ZIP |
CERTIFICATION STATEMENT: I certify under penalty of law that I am entitled to personal information from the requested driver record. I am aware that there are criminal and civil penalties for knowingly obtaining, disclosing, or using the personal information for a purpose not permitted under DPPA (18 U.S.C. §§
_________________________________________
(Signature of person requesting driving record)
Fee of $6.00 enclosed.
PERSON TO WHOM THE MVR PERTAINS
The requester listed above requests access to driver record(s), including personal information as defined in 18 U.S.C. §§
Name _____________________________ |
_____________________ |
___________ |
___________________ |
(Last) |
(First) |
(Middle) |
(Date of Birth) |
Driver License Number _______________ Address (if available) _______________________________________
APPROVAL OF THE PERSON TO WHOM THE MVR PERTAINS
I am the individual to whom the MVR pertains and am the subject of the record. I grant permission for the above requester to receive a copy of my Utah driver license record (MVR) from the Utah Driver License Division.
DLD USE ONLY
Date received
DLD employee
DLD60
REV.
_______________________________________
Driver’s Signature
Sworn and subscribed to before me this______of_________________20_____
In the county of __________________________State of __________________
Notary Signature _________________________________________________
Notary Public Seal or Stamp
Notary expires:___________________________________________