New York Form Request PDF Details

If you're a New Yorker and have to file a request with a government agency, you'll need the New York Form Request. This form is used to simplify the process of filing requests for information or documents from agencies within the state of New York. The form can be used for both personal and business requests, and can be filled out online or printed out and filled in by hand.

Here's some specifics to help you figure out how long you will need to complete the new york form request.

QuestionAnswer
Form NameNew York Form Request
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesny mv 15, new york mv 15, how to form mv 15 dmv, your dmv mv form

Form Preview Example

REQUEST FOR CERTIFIED DMV RECORDS

NRTNRRN

YOUR OWN RR

 

Toorderyorowrecordboaerecorde

icheckicoeaofereireeid

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erecordieoaeboofiecoo

 

 

Provide the name and address of where to send your record(s) in Step.

Provide your name, address and signature in Step.

Check the box next to each type of record that you want and provide as much search information as possible in Step .

Enclose an acceptable form of payment according to the instructions in Step.

Include a photocopy of your driver license or government-issued identification card with this request form or have your

signature notarized in Step .

NT Sometimes, title (vin) abstracts may contain the names of other individuals, so you must check one or more of the permissible uses that are listed and sign the certification in Step.

NRTNRRN

ANOTHER PERSON’S RR

Toorderaoerero’recordeichecki

coeaofereireeidbeowo

Provide the name and address of where to send the record(s) in Step.

Provide your name and address in Step.

Check the box next to each type of record that you want and provide as much search information as possible in Step.

Enclose an acceptable form of payment according to the instructions in Step .

Have one or more of the permissible uses described in Step. Checkallofthepermissibleusesthatapplyandsignthecertification.

Include a photocopy of your driver license or government-issued identification card with this request form or have your

signature notarized in Step .

 

eofrofee

 

GovernmentAgencies; public officers, boards or bodies; volunteer fire companies and ambulance services; legal aid

 

bureaus or societies or any private entity acting pursuant to NY County Law § 722 are exempt as long as theAgency identifies themselves,

 

that the records being requested are for business use, and the records are mailed to the requestingAgency’s business address.

 

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MAIL YOUR coedforayeadideficao

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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N

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No record

ABS___ HIS___ TCK___ SUS___ APP___ INS___ $_____

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Abstract(s)

Life___

Stnd___

Reg___

Ttl___

$_____

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Application

 

 

 

 

 

 

 

$_____

 

 

iTyeaeadaiig

 

 

 

addrewheree

 

Ticket(s)/Disposition(s)

 

 

 

 

$_____

 

 

 

 

 

 

 

 

 

 

 



recordwibeaied



 

 

 

 

 

 

Suspensions/Revocations

Lic___

Reg___

$_____

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Insurance Search Activity Report

 

 

$_____

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TT

$

 

Address2

 

 

 

 

 

 

 

 

 

 

 

 

Initials ____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City,

State,

Zip

Date ____________

FT # ____________

Amount Received

$

REFUND (IFANY)

$

MV-15 (7/18)

RR’NRTN

LAST NAME

FIRST

 

 

M.I.

ADDRESS WHERE YOU GET YOUR MAIL (INCLUDE STREET & NO.)

 

 

APT #

 

 

 

 

 

 

 

CITY

 

STATE

ZIP CODE

SIGNATURE

 

 

 

 

X

 

 

 

 

DAYTIME PHONE NUMBER (RR ):

Check here if the mailing address you provided in Step 1 is different from the requestor’s address.

 

 

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NRTNRR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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recordyoarereeg

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAST NAME

FIRST

 

M.I.

DATE OF BIRTH

SEX

 

N.Y. DRIVER OR NON-DRIVER ID #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS (INCLUDE STREET & NO.)

APT #

CITY

 

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TICKET NUMBER of SUSPENSION ORDER NUMBER

 

DATE OF VIOLATION

OFFENSE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LICENSE

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RVNRT

 

(displays records for the last 4 years)

RVNRR

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referred to as LIFETIME ABSTRACT”)

DMV can only provide this type of abstract to the individual whose name is on the record. Examples of when this may be required include: background checks, bar exam, applicants for a license in U.S. or Canada, and an attorney reviewing client’s entire record.

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Go to dmv.ny.gov to get the form.

 

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0

x$ each $

REGISTRATION / OWNER

Note - this history does not always include information that dates back to when a person was originally granted driving privileges. Some information is purged, as required by law.

RR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

(only your own address history)

. . . . . . . . .

. . . . . . . . . . . . . . . .

. . . .

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x$

each

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0

 

TTN

(includesphotocopyofticketorcopyofelectronicrecord)

. . . .

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. . . . . . . . . . . . . . .

 

 

x$

each

$

 

 

 

 

 

 

 

 

 

 

DMV does not retain parking tickets - contact city, town or village

 

 

 

 

 

 

 

 

 

 

 

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IFYOUWANTMORETHANONETICKET,DISPOSITION,ORSUSPENSIONORDER,PLEASEATTACHALISTANDINCLUDE$10FOREACHONE

 

 

 

 

 

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LAST NAME

 

 

 

 

 

FIRST

 

 

 

 

M.I.

DATE OF BIRTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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PLATE

 

YEAR

MAKE

 

MODEL

 

VIN #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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(Owner - only includes active lien information)

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each

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IF YOU WANT MORE THAN ONE PLATE, VINABSTRACT OR SUSPENSION ORDER, PLEASEATTACHALISTAND INCLUDE $10 FOR EACH ONE

Please calculate the total for each of the items you want and enter the total here

 

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DMV Dial-in account number

 

 

 

 

 

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MV-15 (7/18)

PERMISSIBLE฀USE(S)฀&฀CTTN

riverivacyoco c TheFederalDriver’sPrivacyProtectionAct(DPPA)(18U.S.C.§2721.etseq.) (“DPPA”)regulatesaccesstoMotor Vehiclesrecords.RecipientherebycertifiesthattheinformationprovidedhereunderbyDMVshallbeusedsolelyforthefollowingpurpose(s).

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1.Useinanycivil,criminal,administrative,orarbitralproceedinginanycourtoragency,includingtheserviceofprocess,investigationin anticipationoflitigation,andtheexecutionorenforcementofjudgmentsandordersorpursuanttoacourtorder.(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. (18 U.S.C. §2721 (b)(6))

3.Use in providing notice to the owners of towed or impounded vehicles. (18 U.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 of Title 49 of the U.S.C. (18 U.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; (18 U.S.C. §2721 (b)(3)(A)) 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 purposes of preventing fraud by, pursuing legal remedies against, or recovering on a debt or security interest against, the individual. (18 U.S.C. §2721 (b)(3)(B))

6.Use required under NYS Vehicle and Traffic Law,Article 19A- Special Requirements for Bus Drivers. (18 U.S.C. §2721 (b)(14))

7.Use required under NYS Vehicle and Traffic Law,Article 19B - Special Requirements for Commercial Motor Carriers.

(18 U.S.C. §2721 (b)(14))

8.Usebyanygovernmentagency,includinganycourtorlawenforcementagency,incarryingoutitsfunctions.(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. (18 U.S.C. §2721 (b)(1))

10.Use in matters of motor vehicle or driver safety. (18 U.S.C. §2721 (b)(2))

11.Use in matters of motor vehicle theft. (18 U.S.C. §2721 (b)(2))

12.Use in matters of motor vehicle emissions. (18 U.S.C. §2721 (b)(2))

13.Use in matters of motor vehicle product alterations, recalls or advisories. (18 U.S.C. §2721 (b)(2))

14.Use in performance monitoring of motor vehicles, motor vehicle parts and dealers. (18 U.S.C. §2721 (b)(2))

15.Use in motor vehicle market research activities, including survey research. (18 U.S.C. §2721 (b)(2))

16.Use in removal of non-owner records from the original owner records of motor vehicle manufacturers. (18 U.S.C. §2721 (b)(2))

17.Use in the operation of private toll transportation facilities. (18 U.S.C. §2721 (b)(10))

18.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). (18 U.S.C. §2721 (b)(13))

19.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:

 

(18 U.S.C. §2721 (b)(14))

20.

 

Use in research activities and in producing statistical reports, aogaeeroaiforaoiobihedd

icoed

 

 

 

oredcocidivida

(18 U.S.C. §2721 (b)(5))

 

Toknowinglymakeafalsestatementorconcealamaterialfactinthiswrittenstatementisacriminaloffense,punishableunderPenalLawSection

210.45.Inaddition,anyonewhomakesfalserepresentationtoobtainanypersonalinformationfromanindividual’sMotorVehiclesrecordissubject tofederalcriminalfinesundertheDriver’sPrivacyProtectionAct(DPPA).

YOU MUSTATTACHACOPY OF YOUR ID.

cerfy that I have read the Drivers Privacy ProtectionAct (18 U.S.C. Sec 2721 et seq.) and will comply fully with the terms of such law. I also agree to defend, hold harmless and indemnify DMV from all actions brought against DMV, or damages alleged against DMV, for my negligent, improper or unauthorized use or dissemination of the information provided by the DMV.

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MV-15 (7/18)

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