Free MV2896 - Wisconsin

VEHICLE / DRIVER RECORD INFORMATION REQUEST
MV2896 9/2008 Title 18 USC Section 2721-2725 and s.19.36(1) Wis. Stats.

Wisconsin Department of Transportation

Clear Form

NOTE: This form may be photocopied for future use.
This form is also available in .pdf format on the DOT website at www.dot.wisconsin.gov/drivers/forms/mv2896.pdf
This request must be completed before information about a Wisconsin vehicle/driver record can be obtained. Knowledge of what access and uses are permitted under the listed Federal Acts is the responsibility of the requester.

Section A - Requester Information
Name - Firm, or Corporation DMV Agency Code/Account # - If Applicable Area Code-Telephone 7:00 a.m. - 4:30 p.m.

Name - Person Completing This Form

Area Code-Telephone #

Street Address

City

State

ZIP Code

Mailing Address (If Different from Above)

City

State

ZIP Code

Section B - Record Information Request - Complete if requesting individual driver/vehicle records only.

I (we) request the following record information: Please provide information for each individual driver record or vehicle that you are requesting.

Check One:

Driver Record Information
Name of Person about whom record(s) are being requested 1 2 Check One:

Certified Driver Record Information
Wisconsin Driver License Number Birth Date

Motor Vehicle Record Information
Please explain request in Comments area below Vehicle Year 1 2 Make

Certified Motor Vehicle Record Information
Current Plate No. or DisID No. Information Requested
Current Owner

Vehicle Identification Number

or or

* History of All Owners

or

* Note: If you request the history of all owners, an additional charge of $5 per owner will be assessed. Comments - Please be specific when describing your request, for example, lien information, a complete history, current owner only, etc.

Section C - Authorization - Please check the statement below that allows you authorization to obtain personal information. Sign certification.
I (we) are authorized under the Federal Driver's Privacy Protection Act to obtain the identified records and personal information based on the following:

1. Authorized for use, if the requester demonstrates that they have obtained the written consent from the person about whom the information pertains. This is not for DMV account holders. (a) I am requesting a copy of my own record. (b) I am a parent or legal guardian of a minor child and am requesting a copy of his/her record. (c) I am requesting the record of another person and have attached their written consent. 2. For use in connection with matters of motor vehicle or driver safety and theft; motor vehicle emissions; motor vehicle product alterations, recalls, or advisories; performance monitoring of motor vehicles, motor vehicle parts and dealers; motor vehicle market research activities, including survey research; and removal of non-owner records from the original owner records of motor vehicle manufacturers to carry out the purposes of the Automobile Information Disclosure Act, the Anti-Car Theft Act of 1992, and the Clean Air Act. 3. A government agency (federal, state, local or tribal) or employed by such, for the purpose of the government agency to carry out its functions.

Please sign on the reverse side.

4. A federal, state, circuit, local, or tribal court, or employed by such, for the purpose of the court to carry out its functions. 5. A Wisconsin or out-of-state law enforcement agency, or employed by such, for the purpose of the law enforcement agency to carry out its functions. 6. Authorized representative, agent, contractor, or employed by such, of a legitimate business and the
vehicle/driving record being requested will be used for normal course of business, but only to:
a. Verify accuracy of the personal information; b. Obtain correct information, but only for purposes of preventing fraud, pursuing legal remedies, or collecting a debt. 7. Authorized for use in connection with any civil, criminal, administrative, or arbitral proceeding in any federal, state, circuit, local, or tribal court or agency, or before any self-regulatory body, including the service of process, investigation in anticipation of litigation, and the execution or enforcement of judgments and orders, or pursuant to an order of a federal, state, circuit, local, or tribal court. 8. Authorized for use in research activities and producing statistical reports, as long as the personal information is not published, redisclosed, or used to contact individuals. 9. Authorized representative, agent, contractor, or employed by such, of an insurer, insurance support organization or self-insured entity and the vehicle/driving record(s) being requested will be used only in connection with the following: a. Claims investigation; b. Anti-fraud activities; c. Rating or underwriting. 10. Authorized for use in providing notice to the owners of towed or impounded vehicles. 11. Authorized representative or owner of a licensed private investigative agency or licensed security service and the vehicle/driving record is being requested for the use of purposes permitted under the Federal Driver's Privacy Protection Act. 12. Authorized as an employer, or its agent or insurer for use in obtaining or verifying information relating to a holder of a commercial driver license (CDL). 13. Authorized representative or owner of a private toll transportation facility for use in the operation of the facility. The Driver Privacy Protection Act (DPPA) is enforced by the U.S. Department of Justice, which may seek civil and criminal penalties for improperly obtaining, disclosing, or using personal information from a motor vehicle record for a purpose not permitted by the DPPA. In addition, private citizens may also seek civil damages in Federal Court. Certification I (we) certify that the information and statements on this request are true and correct, comply with the provisions of the Federal Driver's Privacy Protection Act and understand that the willful, unauthorized disclosure of information obtained from these records for a purpose other than stated on this request, or the sale or other distribution of the information to a person or organization not disclosed in this request may result in penalties imposed under Title 18 U.S.C. Section 2724.

X
(Requester Signature) (Date Signed)

NOTE: Incomplete or incorrect information provided in section "B" may result in an additional $5 fee per driver record, and $5 fee per vehicle or DisID record. Also, $0.25 may apply per photocopy. Mail completed form with check or money order made payable to: Registration Fee Trust
Non-Certified Driver Record Fee: $5.00 ea. Certified Driver Record Fee: $10.00 ea.

Print

Non-Certified Vehicle Record Fee: $5.00 ea. Certified Vehicle Record Fee: $10.00 ea.

Mail fee(s) with completed form to:
Driver Records Wisconsin Department of Transportation PO Box 7995 Madison WI 53707-7995

Mail fee(s) with completed form to:
Citations & Withdrawals Section Wisconsin Department of Transportation PO Box 7917 Madison WI 53707-7917

Mail fee(s) with completed form to:
Vehicle Records Section Wisconsin Department of Transportation PO Box 7911 Madison WI 53707-7911

Please attach a stamped, self-addressed envelope for return of the requested information.