Free BDVR-154 Record Lookup Request - Michigan

MICHIGAN DEPARTMENT OF STATE - RECORD LOOKUP REQUEST
If you are requesting records about someone other than yourself, please complete this form. If you are requesting your own record, use form BDVR-153, Requesting Your Own Record.
INSTRUCTIONS FOR COMPLETING THIS FORM
General Information Lookups of driving and vehicle records are available for $7.00 for each record lookup. Certifications cost an additional $1.00 per record. If no record is found, you are still responsible to pay the lookup fee(s). Fill out as much information about your request as you can. Accurate and complete information will help us locate the record(s) you want. Please include a daytime telephone number in case we have questions about your request. All requestors must select at least one of the permissible purposes in Section 4 if personal information contained in the record is needed. Personal information will be redacted (not revealed) if the requestor has not designated a permissible purpose. Driving Records and Personal Identification Card Information ­ Section 2 For driving records, include as much detail in Section 2 as possible. If you just need the name, address, or driving status, request the current record only. If you check more than one box, you will be charged for each record lookup. Personal identification card information is also available. Complete Section 2, Driver Information, substituting the identification card number for the driver's license number. IMPORTANT: If you only need a driving record, do not complete Section 3; otherwise, you will also be charged for vehicle record lookups. Vehicle Registration or Title Information ­ Section 3 For vehicle information, include as much detail as possible. The owner's name should be the owner of record, not a purchaser who has not yet titled the vehicle. If you just need name, address, or ownership verification, request only a registration record. If you request both a registration record and current title information, you will be charged for two records (at least $14.00). Information about proof of insurance at vehicle registration is not retained and is not available. For watercraft, snowmobile, ORV, or mobile home records, complete Section 3, Registration or Title Information, substituting the watercraft or snowmobile registration number for the license plate number or substituting the mobile home serial number for the vehicle identification number. Include as much information as you can about the watercraft, snowmobile, ORV, or mobile home. If you request record information on a specific individual, all other names appearing within the documents that you receive will be redacted (not revealed). Example: If you need all the names associated with a vehicle title history and you provide what you think is the current owner's name, all other names within the documents that you receive will be redacted. Leave the owner's information blank if you need personal information about all owners within the records. You must have a permissible purpose as outlined by state and federal laws to obtain personal information on all owners. If you do not have a valid permissible purpose, personal information will be redacted from the record(s) you receive. IMPORTANT: If you only need vehicle registration or title information, do not complete Section 2; otherwise, you will also be charged for driving record lookups.

SECTIONS 1, 5, AND 6 MUST BE COMPLETED IN ORDER TO PROCESS YOUR REQUEST FOR RECORDS

Clear Form

MICHIGAN DEPARTMENT OF STATE - RECORD LOOKUP REQUEST
If you are requesting records about someone other than yourself, please complete this form. If you are requesting your own record, use form BDVR-153, Requesting Your Own Record.

Section 1. Requestor's Information (Please print or type all information.)
Requestor Name (Individual or Company) Mailing Address City State Zip Code Agent's Name and Title (if company) File or Claim Number Daytime Telephone Number

(
Section 2. Driver Information (If you only need a driving record, leave Section 3 blank.)
Check boxes that apply: Driving Record for:
(Shows last reported address)

)

-

Employment, Credit, or Insurance Court Other: ________________________________

Current Application Application History* For partial histories, please complete: from ______/______/______ to ______/______/______ Address History* Other Driving-Related Record(s) ___________________________________________________ Date ______/______/______
(Hearing, Offense, License Status, etc.)

Driver's Full Name (First, Middle, Last) Driver's Full Name (First, Middle, Last)

Driver's License Number Driver's License Number

Date of Birth Date of Birth

Section 3. Vehicle Registration or Title Information (Insurance information is not retained and is not available.)
Note: $7.00 is charged for each record lookup. Complete histories can be expensive. (If you only need a vehicle record, leave Section 2 blank; otherwise, you will be charged for multiple records.) License Plate or Vehicle Make and Model Vehicle or Hull Identification Number Registration Number Year Check boxes that apply: Current Vehicle Owner and Lienholder Information Registration Information as of ____/____/____ Copy of Current Title Application and Related Forms Complete Title History* Complete Registration History* Partial Title History* For partial histories, please complete: from ______/______/______ to Partial Registration History* Check box if you want: All motor vehicles registered or titled to this owner.** All other registered or titled assets for the owner indicated.** Vehicle Owner(s) Name Vehicle Owner(s) Address City State Zip Code

______/______/______

* Buying a complete or partial title, application, and/or address history can be very expensive. The lookup fee is charged for each address or title change or correction. ** When requesting records for all motor vehicles or all assets registered and/or titled through the Michigan Department of State for individuals and/or companies, precise information is required. Information retrieved is based upon an exact name and address match. The individual's name and address, as provided by the record requestor, must match the name and address on the record(s) held by the Michigan Department of State.

For Office Use Only
BDVR-154-WEB (02/08)

SECTIONS 1, 5, AND 6 MUST BE COMPLETED IN ORDER TO PROCESS YOUR REQUEST FOR RECORDS

Section 4. Permissible Purposes for Obtaining Records and Information (Check those that apply.) A. Permissible reason "A" does not apply on this request form. Government agencies or individuals/business entities
acting on behalf of a governmental agency in carrying out the agency's functions are to complete the Governmental Request form BDVR-155.

______B. For use in connection with matters of motor vehicle, watercraft, snowmobile or off-road recreational vehicle (ORV) and
driver or operator safety or auto, watercraft, snowmobile, or ORV theft; motor vehicle, watercraft, snowmobile, or ORV emissions; motor vehicle, watercraft, snowmobile, or ORV product alterations, recalls, or advisories; performance monitoring of motor vehicles, watercraft, snowmobiles, or ORVs; motor vehicle, watercraft, snowmobile, or ORV market research activities, including survey research; and the removal of nonowner records from the original records of motor vehicle, watercraft, snowmobile, or ORV manufacturers.

______C. For use in the normal course of business by a legitimate business, including the agents, employees, and contractors of the
business, but only to verify the accuracy of personal information submitted by an individual to the business or its agents, employees, or contractors, and if the information as so submitted is no longer correct, to obtain the correct information, for the sole purpose of preventing fraud by pursuing legal remedies against, or recovering on a debt against, the individual.

______D. For use in connection with a civil, criminal, administrative, or arbitration proceeding in a federal, state, or local court or
governmental agency or before a self-regulatory body, including use for service or 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, administrative agency, or a self-regulatory body.

______E. For use in legitimate research activities and in preparing statistical reports for commercial, scholarly, or academic
purposes by a bona fide research organization, if the personal information is not published, redisclosed, or used to contact individuals.

______F. For use by an insurer or insurance support organization, or by a self-insured entity, or its agents, employees, or
contractors, in connection with claims investigating activity, antifraud activity, rating, or underwriting.

______G. For use in providing notice to the owner of an abandoned, towed, or impounded vehicle, watercraft, snowmobile, or ORV. ______H. For use either by a private detective or private investigator licensed under the Private Detective License Act of 1965 (1965
PA 285; MCL 338.821 to 338.851), or by a private security guard agency or alarm system contractor licensed under the Private Security Guard Act of 1968 (1968 PA 330; MCL 338.1051 to 338.1085), only for one or more of the permitted purposes listed on this page. List purpose(s) here: Your professional license number:

______I.

For use by an employer, or the employer's agent or insurer, to obtain or verify information relating either to the holder of a commercial driver's license that is required under federal law or to the holder of a chauffeur's license that is required under Chapter 3 of the Michigan Vehicle Code. For use by a watercraft, snowmobile, ORV, or car rental business, or its employees, agents, contractors, or service firms, for the purpose of making rental decisions.

______J.

______K. For use in connection with the operation of private toll transportation facilities. ______L.
For use by a news medium in the preparation and dissemination of a report related in part or in whole to the operation of a motor vehicle or public safety.

M. Permissible reason "M" does not apply on this request form. An individual requesting information pertaining to himself
or herself or requesting in writing that the Secretary of State provide information pertaining to himself or herself to the individual's designee is to complete the Requesting Your Own Record form BDVR-153. SECTION 4 MUST BE COMPLETED TO OBTAIN PERSONAL INFORMATION

Section 5. Payment Method
(Include payment, credit card billing information, or Michigan Department of State Account Number.) The cost for each record lookup is $7.00. Each certified record provided is $8.00. If "no record" is found, you are still responsible to pay for each lookup. Check or Money Order Certified record needed (Payable to "State of Michigan") ($1.00 additional per record) Michigan Department of State Account Number _____________________ Name on Credit Card
(PLEASE PRINT)

Credit Card Discover Expiration Date

MasterCard

VISA

Credit Card Account Number If paying by credit card, I authorize charging the total amount to my credit card.

X___________________________________________
Signature of Cardholder

____ / ____ / ____
Date

Section 6. Requestor Certification (This section must be completed or request will not be processed.)
All requestors must select at least one of the permissible purposes in Section 4 and provide an explanation below if personal information contained in the record is needed. Personal information will be redacted (not revealed) if the requestor has not designated a permissible purpose and provided an explanation below. Explain the reason why you need personal information contained in driving and/or vehicle records: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ I certify that the information and statements on this request are true, correct, and comply with the provisions of state and federal driver privacy laws. I understand that the willful unauthorized disclosure of information obtained from these record(s) for a purpose other than stated on this request, or the sale or other redisclosure of personal information to a person or organization not identified in this request, may result in penalties imposed under MCL 28.295a, 257.902, 257.903, 324.80130d, 324.80319a, 324.81120, 324.82160 and other provisions of law.

X___________________________________________
Signature of Requestor ­ form must be signed or request will not be processed.

____ / ____ / ____
Date

Penalties for Misuse: Under Michigan law, a person who makes a false representation or a false certification to obtain personal information or who uses personal information for a purpose other than a permissible purpose identified in law is guilty of a felony, which may be punishable by imprisonment for up to 5 years and/or a fine of up to $5,000. Subsequent convictions may result in imprisonment for up to 15 years and/or a fine of up to $15,000.

Mail your completed request to: Michigan Department of State Record Lookup Unit 7064 Crowner Drive Lansing, Michigan 48918-1540
Read the instructions for guidance or call 517.322.1624 for help in completing this form. Completed requests may be faxed to 517.322.1181 but must be charged to a credit card or Michigan Department of State account.

www.Michigan.gov/sos
Authority granted under Public Act 300 or 1949, as amended (35,000, $1,068, $0.03)

BDVR-154-WEB (02/08)