Mvd 11260 Form PDF Details

The MVD-11260 form, a document overseen by the State of New Mexico’s Taxation & Revenue Department, serves a vital role in the management and release of confidential motor vehicle records. In line with the strict privacy provisions outlined in the New Mexico Motor Vehicle Code, the form is designed to safeguard personal information while facilitating its release under specific circumstances. It targets two main audiences: individuals or their authorized representatives and requestors with written consent from the individual whose information is being sought. The form is comprehensive, delineating between vehicle and driver records and specifying the type of personal information covered, which ranges from driver license numbers to social security numbers and even physical descriptors in the case of driver records. Requirements for the requestor's identity, specifications on the type of information requested (including driver-related details like motor vehicle record copies or vehicle-related data such as registration printouts), and the necessity for a notarized release if information is being requested by a third party, underline the form’s thorough approach to privacy. Furthermore, adherence to the National Driver’s Privacy Act emphasizes the legal responsibility borne by the requester to use the disclosed information appropriately. The MVD-11260 not only represents a procedural necessity but also underscores a commitment to privacy and legal compliance in the dissemination of sensitive information.

QuestionAnswer
Form NameMvd 11260 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmvd11260 how to fill out a mvd confidential record release form

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MVD-11260 REV. 03/01

State of New Mexico - Taxation & Revenue Department

MOTOR VEHICLE DIVISION

CONFIDENTIAL RECORDS RELEASE

(Pursuant to Section 66-2-7.1, NMSA 1978)

TYPE OR PRINT PLAINLY (INQUIRIES THAT CANNOT BE READ WILL NOT BE PROCESSED)

ProvisionsoftheNewMexicoMotorVehicleCodemakepersonalinformationaboutanindividualconfidential,andrestrictdisclosure. This form authorizes the release of Driver or Vehicle information containing personal information to:

•an individual, or an individual's authorized representative; or

•a requestor, if the requestor has obtained the written consent of the individual to whom the information pertains.

NOTE: For purposes of this Release, the term "personal information" means:

•with respect to VEHICLE RECORDS, the driver license number, date of birth, address, city and state.

•withrespecttoDRIVER RECORDS,thename,address,city,state,socialsecuritynumber,driverlicensenumber,dateofbirth,height, weight, medical restrictions, image and signature.

REQUESTOR / AUTHORIZED REPRESENTATIVE NAME & ADDRESS

REQUESTOR' S NAME - Company or Individual - (Last, First, MI ):

Requestor'sSS#orEmployerID#

MailingAddress(Number&Street):

 

 

City,State,ZipCode:

 

 

 

 

 

 

 

 

PERSONTOWHOMINFORMATIONPERTAINS

 

 

 

 

 

 

 

NAME (Last, First, MI)

PERSON TO WHOM INFORMATION PERTAINS

Mo./ Day / Yr. of Birth

 

 

 

 

 

 

 

 

MailingAddress(Street&Number)

 

 

 

SocialSecurity#

 

 

 

 

 

 

City,State,ZipCode

 

 

 

Telephone#

 

 

 

 

(

)

 

 

 

 

 

DriverLicense/IDCard Number(IfApplicable)

 

VehicleLicensePlate /IdentificationNumber(s) (IfApplicable)

 

 

 

 

 

 

 

TYPEOFINFORMATIONREQUESTED

DRIVER RELATED

Motor Vehicle Record

Copies of Citations or Withdrawal Notices

Copy of License / ID Card Application

Other: ____________________________

__________________________________

__________________________________

__________________________________

VEHICLE RELATED

PrintoutofVehicleRegistration/OwnerInformation

CopyofVehicleorTitleorMSO

CopyofBillofSale

Other: ____________________________________

__________________________________________

__________________________________________

__________________________________________

Provideadditionalinformationtoaccuratelyandspecificallyidentifytheinformationrequestedabove:________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

PursuanttotheNationalDriver'sPrivacyAct,PublicLaw103-322,Iherebyswearandaffirmthatthisrequestedrelease of information is permissible and will be used according to law.

The undersigned takes full responsibility for any violations of this Act.

I authorize the release of my personal information to: Me Authorized Representative Requestor

Signature of Person

to Whom Information Pertains ___________________________________________________________ Date ________________

If personal information is to be released to anyone other than the individual, this Release must be notarized.

THIS RELEASE IS

VALID FOR 30 DAYS

FROM DATE OF AUTHORIZATION

NOTARY: Subscribed and sworn to before me at _______________________, this________ day of _________________, 19 ____. Signed______________________________________________________

My commission expires: _____________________________

SEAL

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This PDF doc will require some specific information; in order to guarantee accuracy and reliability, remember to take into account the guidelines directly below:

1. You have to complete the Mvd 11260 Form accurately, hence take care while working with the areas including these specific blank fields:

Part # 1 for completing Mvd 11260 Form

2. Given that the previous part is finished, you should insert the essential details in Provide additional information to, Pursuant to the National Drivers, If personal information is to be, NOTARY Subscribed and sworn to, THIS RELEASE IS, VALID FOR DAYS, this day of, Signed, FROM DATE OF AUTHORIZATION, My commission expires, and SEAL in order to progress to the next step.

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