Mv 15C Form – Fill Out and Use This PDF

Driver records contain the following information:

wconvictions, suspensions, revocations, accidents, accident prevention course completion (for more information, refer to form DS-242.1)

DMV records do not contain the following information:

wtickets, address history, convictions and/or accidents beyond their retention period, date first licensed, vehicle information

You can request your record.

You can request another person’s record.

INSTRUCTIONS:

wAseparate form, MV-15C, must be used for each search requested.

wYou must show documents to prove your identity (see form ID-44 for acceptable proofs of identity).

wTheVehicleandTrafficLawrequiresthatDMVchargea$10searchfee.Youmustpaythefeeevenifthedriverrecordisnotfound.

You can pay the fee with a check made payable to “Commissioner of MotorVehicles”.According to section 202 of theVehicle andTraffic Law, the fee to search a record is not charged to: any public officer, board or body; a volunteer fire company; a volunteer ambulance service; a legal aid bureau, society or private entity that acts pursuant to Section 722 of the County Law.

If DMV can not find a license record with the information you provide, DMV will send you written notification to advise you that the requested record was not found.

I request my own record.

I request another person’s record. (Complete SectionAand Section B).

(Complete SectionAONLY)

Youmustwriteyourinitialsnexttothe“permissibleuse”thatappliestoyourrequestonPage2ofthisform.

A. INFORMATIONABOUT THE DRIVER RECORD YOU REQUEST:

DRIVER LICENSE ID#

OR

NAME (Last,First,Middle)

DATE OF BIRTH

SEX

Month

Day

Year

M

F

B. YOUR INFORMATION:

NAME (Last,First,Middle)

DATE OF BIRTH

SEX

Month

Day

Year

M

F

STREETADDRESS

APT. #

CITY OR TOWN

STATE

ZIP CODE

Sign Hereç

Date

CREDIT CARDAUTHORIZATION

Your Signature (required)

Mysignatureauthorizestheuseofmycreditcardforpaymentofanyfeesinconnectionwiththisrequest.IunderstandthatImustbepresentforthistransaction.

Sign Hereç

Date

(Cardholder-Sign Name in Full)

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NewYork State Department of MotorVehicles

LIST OF PERMISSIBLE USES

DRIVER PRIVACY PROTECTIONACT

The Federal Driver’s Privacy Protection Act (18 U.S.C. §2721.et seq.) (“DPPA”) regulates access to Motor Vehicles records. Recipient hereby certifies that by placing your initials below, that the information provided hereunder by DMV shall be used solelyforthefollowingpurpose(s).

1.____ Use in any civil, criminal, administrative, or arbitral proceeding in any court or agency, including the service of process, investigationinanticipationoflitigation,andtheexecutionorenforcementofjudgmentsandordersorpursuantto acourtorder.(18U.S.C.§2721(b)(4))

2.____ Use by an insurer or insurance support organization or self-insured entity in claims investigations, anti-fraud activities, rating or underwriting activities. (18U.S.C.§2721(b)(6))

3.____ Use in providing notice to the owners of towed or impounded vehicles. (18U.S.C.§2721(b)(7))

4.____ Use by an employer, its agent or insurer to obtain information relating to the holder of a commercial driver's license required under Chapter 313 ofTitle 49 of the U.S.C. (18U.S.C.§2721(b)(9))

5.____ 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 (18U.S.C.§2721(b)(3)(A))

(B)if such information as so submitted is not correct or is no longer correct, to obtain the correct information, but only for the purposes of preventing fraud by, pursuing legal remedies against, or recovering on a debt or security interest against, the individual. (18U.S.C.§2721(b)(3)(B))

6.____ Use required under NYSVehicle andTraffic Law,Article 19A- Special Requirements for Bus Drivers.

(18U.S.C.§2721(b)(14))

7.____ Use required under NYSVehicle andTraffic Law,Article 19B - Special Requirements for Commercial Motor Carriers. (18U.S.C.§2721(b)(14))

8.____ Use by any government agency including any court or law enforcement agency, in carrying out its functions.

(18U.S.C.§2721(b)(1))

9.____ Use by any private person or entity acting on behalf of a federal, state, or local agency in carrying out its functions. (18U.S.C.§2721(b)(1))

10.____ Use in matters of motor vehicle or driver safety.

(18U.S.C.§2721(b)(2))

11.____ For use by any requester, if the requester demonstrates it has obtained the written consent of the individual to whom the information pertains. (May use form MV-15GC). (18U.S.C.§2721(b)(13))

12.____ Use specifically authorized under NYS law, IF such use is related to the operation of a motor vehicle or public safety. Cite the specific NYS law here: ________________________________________________________

(18U.S.C.§2721(b)(14))

To knowingly make a false statement or conceal a material fact in this written statement is a criminal offense, punishable under Penal Law Section 210.45. In addition, anyone who makes false representation to obtain any personal information from an individual’sMotorVehiclesrecordissubject tofederalcriminal finesunderthe Driver’sPrivacyProtectionAct (DPPA).

MV-15C (6/13)

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