Fillable Form Connecticut Driving Record Request (2015)

What is the Connecticut Driving Record Request form?

Form J-23, Connecticut Driving Record Request Form, is used to request a copy of driver’s records from Connecticut’s Department of Motor Vehicle (DMV). Connecticut DMV keeps records of their registered drivers, which includes changes to the driver’s account such as tickets and violations, and other convictions.

Anyone with a commercial or standard driver’s license or learner’s permit can acquire records from the DMV.

Why do you need to request a copy of your driver record?

Request a copy of your driver record to know your driving history report and protect your driving privileges. It helps find errors on your account and correct them early with Connecticut DMV.

Having errors on your report may affect your car insurance. A car insurance company requires a copy of your Connecticut driving record to decide whether to extend your insurance coverage or not.

How to fill out the Connecticut Driving Record Request form?

REMINDERS

• If the registration is lost and you need a replacement, complete Form B-34, Request for a Duplicate Motor Vehicle Registration-Connecticut.
• A private investigator’s license must be shown and recorded, along with a second form ID.
• You must furnish an identification that has your photo, preferably a driver’s license or passport. Otherwise, your request may not be processed.

LICENSE RECORDS, CHECK (?) REQUEST(S) BELOW

Identify your request by marking any of the following.

Driver License File Information

Mark the box if you request the printout of license class, endorsements, restrictions, original issue date, and status. Current information regarding your request is available for $20.

Driver License Application

Mark the box if you request a copy of the most current document of the driver’s license application. The unit price is $20. Note that this is not a duplicate license.

Driving History

Mark the box if you are requesting a list of your current driving history or any other convictions mandated by law. The unit price is $20.

Reg

Mark the box if it is a Regular Driver’s License.

CDL

Mark the box if it is a Commercial Driver’s License.

REGISTRATION RECORDS

Identify your request for registration records by marking any of the following. Each unit price is $20.

Registration File Information

Mark the box if you request a copy of the current computer record of your registration file. Fill in sections two and/or three.

Registration Certificate

Mark the box if you request the registration certificate for the current year. Fill in sections two and/or three. Note that this is not a duplicate registration.

Registration Return Plate Receipt

Mark the box if you request the current computer record of your registration return plate receipt. Fill in sections two and three.

Insurance Information Only

Mark the box for a copy of your insurance information for the current year or date specified. The original insurance information is listed on Form H-13 or the Official Registration of a Motor Vehicle and Application for Certificate of Title.

Miscellaneous Request

Mark the box for any miscellaneous requests. Fill in section four.

Multiple Request?

Mark the box for multiple requests. Please complete one Connecticut Driving Record Request form and attach a separate sheet with the required information for each request.

Certified Copy of Uncertified Items

Mark the box if you request a certified copy of uncertified items. Add $20 to the unit price of each item.

DMV USE ONLY- ID CHECK

Do not enter anything here.

ATTORNEY'S JURIS #

Enter the Attorney’s Juris number.

ATTORNEY NAME OR CASE NAME AND COURT LOCATION

Enter the name or case name of your attorney and the court location.

REQUEST SECTION

List down the information necessary for each request. DMV requires two identifying characteristics found on a record request.

CODE NO.

Enter the applicable code number. Code numbers 1 to 9 are for those who wish to obtain record information on others. Code number 10 is for those who wish to obtain their record information.

1. By any federal, state, or local government agency in carrying out its functions or any individual or entity acting on behalf of any such agency. (Official letterhead or business card and photo ID must be included - government exempt from fees.

2. In connection with matters of a motor vehicle or driver safety and theft, motor vehicle emissions, motor vehicle product alterations, recalls or advisories, performance monitoring of motor vehicles and dealers by motor vehicle manufacturers, motor vehicle market research activities including survey research, motor vehicle product, and service communications and removal of nonowner records from the original owner records of motor vehicle manufacturers to implement the provisions of the Federal Automobile Information Disclosure Act, 15 USC 1231 et seq., the Clean Air Act, 42 USC 7401 et seq., and 49 USC Chapters 301, 305, and 321 to 331, inclusive, as amended from time to time, and any provisions of the general statutes enacted to attain compliance with said federal provisions.

3. In the normal course of business by the requesting party, but only to confirm the accuracy of personal information submitted by the individual to the requesting party. (Full name and address of individual required)

4. In connection with any civil, criminal, administrative, or arbitral proceeding in any court or government agency or before any self-regulatory body, including the service of process, an investigation in anticipation of litigation by an attorney-at-law or any individual acting on behalf of an attorney-at-law and the execution or enforcement of judgments and orders, or according to an order of any court provided the requesting party is a party in interest to such proceeding. (Attorney Name or Case Name and Court Location- REQUIRED)

5. In connection with matters of a motor vehicle or driver safety and theft, motor vehicle emissions, motor vehicle product alterations, recalls or advisories, performance monitoring of motor vehicles and motor vehicle parts and dealers, producing statistical reports, and removal of nonowner records from the original owner records of motor vehicle manufacturers provided the personal information is not published, disclosed or used to contact individuals.

6. By any insurer or insurance support organization or by a self-insured entity or its agents, employees, or contractors, in connection with the investigation of claims arising under insurance policies, anti-fraud activities, rating, or underwriting.

7. In providing any notice required by law to owners or lienholders named in the certificate of title of towed, abandoned, or impounded motor vehicles [or to owners named in the registration record in the case of any vehicle for which no title has been issued].

8. By an employer or its agent or insurer to obtain or verify information relating to a holder of a passenger endorsement or commercial driver's license required under 49 USC Chapter 313, and Connecticut General Statutes sections 14-44 to 14-44m, inclusive, as amended.

9. I have obtained and am presenting evidence of consent to the disclosure by the subject(s) of the record.

10. This record request is submitted for the purpose of obtaining my record on file at the Department of Motor Vehicles.

SIGNATURE OF APPLICANT

Sign the form.

PRINTED NAME OF THE APPLICANT

Enter your name in UPPERCASE format.

DATE SIGNED

Enter the date when you signed the form.

SECTION 1

Fill in this section for requests for Driver License File Information, Driver License Application, or Driving History.

Driver’s Name

Enter the driver’s name.

Driver’s License Number

Enter the driver’s license number.

Driver’s Date of Birth

Enter the driver’s date of birth.

Driver’s Address

Enter the driver’s address including the number and street, city or town, state, and ZIP Code.

SECTION 2

Fill in this section for Registration File Information, Registration Certificate, Registration Return Plate Receipt, and Insurance Information.

Owner’s Name

Enter the owner’s name.

Owner’s Address

Enter the owner’s address including the number and street, city or town, state, and ZIP Code.

SECTION 3

Fill in this section for Registration File Information, Registration Certificate, Registration Return Plate Receipt, and Insurance Information.

Vehicle Identification Number

Enter the Vehicle Identification Number (VIN).

Vehicle Make

Enter the vehicle make or the car’s brand.

Vehicle Year

Enter the vehicle year. It could be the 10th digit in the VIN.

Registration Plate Number

Enter the registration plate number.

As of

Enter the date.

SECTION 4

Fill in this section for miscellaneous requests.

Miscellaneous Request

Enter your miscellaneous request.

QTY

Specify the number of copies of your request.

UNIT PRICE

Enter its unit price.

AMOUNT

Enter the total amount based on the number of your copies and their unit price.

TOTAL AND AMOUNT RECEIVED

This is for DMV use only.

APPLICANT

Enter your name and mailing address.

Customer Number

Enter your customer number.

Operator’s License No. or FED. Employer ID No.

Enter the operator’s license number or the federal employer identification number.

Telephone No.

Enter your telephone number.

Name

Enter your name.

Number and Street

Enter your number and street. If you are using a post office box, the street address is a must.

City or Town

Enter your city or town.

State

Enter your state. You may click on the space to see state codes.

Zip Code

Enter your ZIP code.

How to file the Connecticut Driving Record Request form?

Mail the accomplished form to the Department of Motor Vehicles, Copy Records Unit, 60 State Street, Wethersfield, CT 06161-0503.