Idaho Itd 3374 Form – Fill Out and Use This PDF

Incomplete applications will be returned. No refunds will be processed whether or not a record is found.

Requestor/Agency Information

Requesting Company Name (Print)				FEIN
Requestor or Company Authorized Representative's Name (Print)				Drivers License or SSN
Address			City		State	Zip
Phone Number	Preferred Method of Receiving Response
	Mailed	E-Mailed To		Faxed To

Authorization To Receive Request (See page 2 for detailed Authorization Definitions and Requirements)

Per Idaho Code Section 49-203, in order to receive personal information found in motor vehicle records, by signing below I certify under penalty of perjury pursuant to the law of the state of Idaho that I meet the authorization listed below and that the use of such information will be strictly limited to the use described on this form.

I certify that I meet the requirements for authorization number

. (Determine your authorization from the list on Page 2.)

I do not meet the requirements for authorization and request only the release of non-personal information.

Request Type and Associated Fees

Total Remittance $

Request Types followed by * must be processed by ITD. Requests processed by ITD take approximately one week.

Vehicle Identification Number

Plate Number

Make

Model

Year

1.

2.

3.

Name (Include Variations)

Address

City

State

Zip

1.

2.

3.

Payment Information – Credit Card, Check, or Money Order - Do Not Send Cash

Credit Card Type

Card Number

Expiration Date

Security Code

Visa

MasterCard

Cardholder’s Signature (Required if paying by credit/debit card)

Date

X

Credit card purchases are subject to an ITD service fee.

~ For mailing or faxing instructions - See Page 2 ~

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Requestors Authorized to Receive Personal Information Under IDAHO CODE, SECTION 49-203*

1.Government: For use by any 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.

2.Driver or Vehicle Safety: For use in 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 parts, and dealers; motor vehicle market research activities, including survey research; and removal of non-owner records from the original records of motor vehicle manufacturers.

3.Business Activities: For 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 personal information submitted by the individual to the business or its agents, employees or contractors; and

b)If such information as so submitted is not correct or is no longer correct, to obtain the correct information, but only for the purpose of preventing fraud by pursuing legal remedies against, or recovering on a debt or security interest against, the individual

4.Court Proceedings: For 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 services 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.

5.Research: For use in research activities, and for use in producing statistical reports, so long as personal information is not published, re-disclosed or used to contact individuals.

6.Insurance: For 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, rating or underwriting.

7.Towed/Impounded Vehicles: For use in providing notice to the owners of towed or impounded vehicles.

8.Investigation: For use by any licensed private investigative agency or licensed security service for any purpose permitted under the provisions of IDAHO CODE, TITLE 49.

9.Employer Information: For use by an employer or its agent or insurer to obtain or verify information relating to a holder of a commercial driver's license that is required under the Commercial Motor Vehicle Safety Act of 1986 (49 USC 31101 et seq.).

10.Public Safety/Vehicle Operation: For any other use specifically authorized under IDAHO CODE, if such use is related to public safety or the operation of a motor vehicle.

11.Transportation Facilities: For use in connection with the operation of private toll transportation facilities, including companies that operate parking facilities for the purpose of providing notice to the owners of vehicles who have used the facility.

12.Written Consent Given: The individual being inquired about has authorized the requestor to have access to their

personal information, in writing. A verified copy of the signed authorization must be included with the MVR request.

____________________

*Release of an individual's photograph, digitized image of a photograph, digitized signature, social security number and medical or disability information may not be disclosed without the written consent of the person to whom such information pertains, except for uses permitted under IDAHO CODE, SECTION 49-203, SUBSECTIONS (4)(A) AND (4)(D).

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