Form Rv F1313801 – Fill Out and Use This PDF

TENNESSEE DEPARTMENT OF REVENUE

VEHICLE SERVICES DIVISION

VEHICLE INFORMATION REQUEST

This request must be completed before motor vehicle information can be obtained from the Tennessee Department of Revenue. Knowledge of what access and uses are permitted under the listed State and Federal Acts is the responsibility of the requester.

SECTION A. Requester Information

Name (Individual, Firm, Corp. or Government Entity) _________________________________________________________________

Name and Title (Person requesting information)		_____________________________________________________________________
Street Address	________________________________________		City, State, Zip	_______________________________________
E-mail Address	________________________________________		Telephone No. _______________________________________
Mailing Address	_______________________________________________________________________________________________

(if different from above)

SECTION B. Vehicle Information Requested (Itemize any additional requests on a separate list and attach.)

Check Items Requested.
 Computer printout of vehicle records: $1.00 per record	 Other (Describe specific information requested.)
 Certified computer printout of vehicle record: $1.50 per record	__________________________________________
Photocopies of all documents for the:	__________________________________________
 Current motor vehicle record: $5.00 per record	__________________________________________
 Complete history of vehicle: $15.00 per history	__________________________________________
Provide any known vehicle information below.

Make _____________ Year _____________ VIN ____________________________________________ Tag # _________________

Name and address of last known owner ______________________________________________________________________________

SECTION C. Authorization: Please check the statement(s) below that describe the purpose(s) for which you will use the requested information.

I (we) are authorized under the Federal Driver's Privacy Protection Act, 18 U.S.C. §§ 2721-2725 (2012), and the Tennessee Uniform Motor Vehicle Records Disclosure Act, TENN. CODE ANN. §§ 55-25-101 through -112 (2012 & Supp. 2013) to obtain the identified records and

personal information for the following use(s):

Use by a government agency, including any court or law enforcement agency, in carrying out its functions, or any private person or entity acting on behalf of a federal, state, or local agency in carrying out its functions. TENN. CODE ANN. § 55-25-107(b)(1). Your request for information must be accompanied by a statement on agency letterhead verifying employment status. TENN. CODE ANN. § 55-25-107(b)(1).

Use in connection with matters of motor vehicle or driver safety and theft, motor vehicle emissions, motor vehicle product alterations, recalls, or advisories, performance monitoring of motor vehicles, motor vehicle parts and dealers, motor vehicle market research activities, including survey research, and removal of non-owner records from the original owner records of motor vehicle manufacturers. TENN. CODE ANN. § 55-25-107(b)(2).

RV-F1313801 (Rev. 5-14)

Use in the normal course of business by a legitimate business or its agents, employees, or contractors, but only:

a.To verify the accuracy of the personal information submitted by the individual to the business or its agents, employees, or contractors, TENN. CODE ANN. § 55-25-107(b)(3)(A); or

b.To obtain correct information if the above is not correct or no longer correct, but only for purposes of preventing fraud, pursuing legal remedies, or recovering on a debt or security interest against the individual. TENN. CODE ANN. § 55-25- 107(b)(3)(B).

Use in connection with any civil, criminal, administrative, or arbitral proceeding in any federal, state, or local court or agency or before any self-regulatory body, including the service of process, investigation in anticipation of litigation, and the execution or enforcement of judgments and orders, or pursuant to an order of a federal, state, or local court. TENN. CODE ANN. § 55-25-107(b)(4).

Use in research activities, and for use in producing statistical reports, so long as the personal information is not published, redisclosed, or used to contact individuals. TENN. CODE ANN. § 55-25-107(b)(5).

Use by any insurer or insurance support organization, or by a self-insured entity, or its agents, employees, or contractors, in connection with claims investigation activities, antifraud activities, rating, or underwriting. TENN. CODE ANN. § 55-25-107(b)(6).

Use in providing notice to owners of towed or impounded vehicles. TENN. CODE ANN. § 55-25-107(b)(7).

Use by any licensed private investigative agency or licensed security service for any exempted use listed. TENN. CODE ANN. § 55-25- 107(b)(8).

Use by any employer or its agent or insurer to obtain or verify information relating to a holder of a commercial driver license that is required under 49 U.S.C. § 31301, et seq. TENN. CODE ANN. § 55-25-107(b)(9).

Use in connection with the operation of private toll transportation facilities. TENN. CODE ANN. § 55-25-107(b)(10).

Use by any requester, if the requester provides written consent of the person to whom the personal information pertains. TENN. CODE ANN.

§§55-25-106, -107(b)(13).

Use as specifically authorized under the law of the State, if that use is related to the operation of a motor vehicle or public safety. TENN. CODE ANN. § 55-25-107(b)(14).

Please describe the proposed use of the information requested, including reference to the Tennessee law under which such use is authorized.

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

SECTION D. Redisclosure

A recipient of motor vehicle records may only resell or redisclose the information disclosed by the Department for uses permitted under the Federal Driver's Privacy Protection Act, 18 U.S.C. §§ 2721-2725 and the Tennessee Uniform Motor Vehicle Records Disclosure Act,

TENN. CODE ANN. §§ 55-25-101 through -112.

A recipient of motor vehicle records shall make and keep for five years, records identifying each person to whom the recipient redisclosed the information and the permitted purpose for which the information was redisclosed. Such records shall be made available upon request for inspection and copying by a representative of the Department of Revenue or Department of Safety. TENN. CODE ANN. § 55-25-107(c).

SECTION E. Certification

I (we) certify that the information and statements on this request are true and correct, comply with the provisions of the Federal Driver's Privacy Protection Act, 18 U.S.C. §§ 2721-2725 and the Tennessee Uniform Motor Vehicle Records Disclosure Act, TENN. CODE ANN.

§§55-25-101 through -112, and understand that the willful, unauthorized disclosure of information obtained from these records for a purpose other than stated on this request, or the sale or other distribution of the information to a person or organization not disclosed in this request may result in penalties imposed under 18 U.S.C. § 2724. I (we) further understand that misrepresentation of my (our) identity or the making of false statements on this application constitutes a Class C misdemeanor, punishable by a fine not to exceed $1,000.00. TENN. CODE ANN. § 55-25-112.

I (we) assume responsibility for all information obtained, pursuant to the Federal Driver's Privacy Protection Act, 18 U.S.C. §§ 2721-2725, and the Tennessee Uniform Motor Vehicle Records Disclosure Act, TENN. CODE ANN. §§ 55-25-101 through -112.

________________________________________	_______________________________________		_____________________
Signature	Driver’s License Number	State	Date Signed

Mail to: State of Tennessee, Department of Revenue Vehicle Services Division

44 Vantage Way, Suite 160

Nashville, TN 37243-8050