Check ONE box unless requesting a juvenile history. Attach one form for each record requested.
Payment: include payment with completed form, by money order, cashier's check, or business check, made out to the Indiana BMV.
Personal checks: ONLY individuals who have an INDIANA BMV record may write a personal check payable to the Bureau of Motor Vehicles.
Step 4: indicate which exception authorizes you to receive protected information, as well as your intended use.
Processing: please allow two (2) to four (4) weeks to process this request.
Ink: complete in blue or black ink or type.
| Question | Answer |
|---|---|
| Form Name | State Form 53789 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 60 |
| Avg. time to fill out | 10 min |
| Edition | R13 / 11-24 |
| Issuing agency | Indiana Bureau of Motor Vehicles |
| Where to send | Bureau of Motor Vehicles, Attn: Records Request, 100 N. Senate Ave., Rm N412, Indianapolis, IN 46204 |
| Other names | State Form 53789, 53789, AI53789, Indiana BMV Request for Certified Records |
| Official source | State Form 53789 (Rev R13 / 11-24), Indiana Bureau of Motor Vehicles |
State Form 53789 isn’t the one you’re looking for?