Fillable Form Nevada Driver Record Request (IR 002)

What is the Nevada Driver Record Request Form?

Form IR200, Application for Record Information, or also referred to as the Nevada Driver Record Request Form, is used by residents of Nevada to request information about their driver’s license, driver history record, or motor vehicle. To receive this information, an applicant must complete an affidavit and a Letter of Authorization to Release Information. An applicant can fill out this form on behalf of his or her organization or business.

How to fill out the Nevada Driver Record Request Form?

Nevada residents can download and print a PDF copy of the Nevada Driver Record Request Form from the Nevada Department of Motor Vehicles (NV DMV) website that they can manually complete. They can also fill out the Nevada Driver Record Request Form electronically on PDFRun.

To fill out the Nevada Driver Record Request Form, you must provide the following information:

Section A

Requester Name

Enter your full legal name.

Business Name

Enter your full business name if it is applicable.

Physical Address

Enter your physical address.

Mailing Address

Enter your mailing address if it is different from your physical address.

Phone Number

Enter your telephone number.

Fax Number

Enter your fax number.

National Association of Insurance Commissioners (NAIC) Number

Enter your National Association of Insurance Commissioners (NAIC) number.

Section B. Information Requested

Driver’s License Information

Mark the appropriate box which corresponds to the type of information you would like to request. You may select:

• Certification (C2)
• Driver’s License Information (D1)
• Clearance Letter (D3)
• Research (S3) - This must be requested along with a Driver’s History Record.

Driver’s History Record (D2)

Mark the appropriate box which corresponds to the type of driver’s history record you would like to request. You may select one from the following:

• 3-year history
• 10-year history
• School bus history
• Original issue date requested - This must be requested along with a Driver’s History Record.
• Handicap placard information

Then, provide the following identifying information:

Full Name

Enter your full legal name.

Date of Birth

Enter your date of birth.

Nevada Address

Enter your residential address in the state of Nevada.

Nevada Driver’s License Number (NDLN)

Enter your Nevada driver’s license number (NDLN).

Social Security Number (SSN)

Enter your social security number (SSN).

Vehicle Information

Mark the appropriate box which corresponds to the document you would like to request for your motor vehicle. You may select:

• Certification (S2)
• Vehicle Registration Printout (V1)
• Title Verification Letter (S4)
• Vehicle Title Printout (V2)
• Vehicle History - You must specify the registration or title.
• Research (S3)
• Insurance Information
• Tax Information Receipt
• Plate Surrendered Receipt or Letter
• Registration (V3a)
• Title (V3b)

Full Name

Enter your full legal name.

Nevada Address

Enter your residential address in the state of Nevada.

Year

Enter the year or model cycle your motor vehicle is in.

Make

Enter the make of your motor vehicle.

Vehicle Identification Number (VIN)

Enter the vehicle identification number (VIN) of your motor vehicle.

Section C. For what purpose is this information needed?

Enter the reason why you are requesting this information.

By signing this Nevada Driver Record Request Form, you hereby declare under the penalty of perjury that the information you have received will not be used for an illegal purpose or an unwarranted invasion of a certain individual’s personal privacy. Furthermore, you must declare that you will not release or sell any of the information you have received through this Nevada Driver Record Request Form to any other party for their use.

Moreover, you must agree to indemnify the state of Nevada, Department of Motor Vehicles, its agents, and employees from any and all claims, cause of action, or liability arising from your carelessness and negligent or improper use of the information you have received through this Nevada Driver Record Request Form.

Signature of Requester

Affix your signature.

Date

Enter the current date of signing.

Affidavit

State of

Enter the state you are currently residing in.

County of

Enter the county you are currently residing in.

You must hereby state the following terms under the penalty of perjury:

• You declare that you have the authority to represent yourself or your organization to enter into this binding agreement. You must have read, fully understood, and agreed to abide by the laws and regulations that are now in effect regarding the personal information you have obtained from the Nevada Department of Motor Vehicles (NV DMV).
• You must understand that any sale or disclosure of the information you have obtained must be in accordance with the provisions of this section. You must keep records of the sales and disclosures you have made for 5 years for the Nevada Department of Motor Vehicles to inspect.
• You must understand that a record will be maintained by the Department of any information you have requested.
• You must understand that a violation of the provisions will be considered as a criminal offense.
• You must understand that you and the organization you represent are required to keep the data, information, reports, tests, manuals, instructions, plans, system designs, computer codes, and other documents you have received from the Nevada Department of Motor Vehicles (NV DMV) strictly confidential. You must agree that you will not disclose any of the items to an individual who is not part of this agreement. The confidential items may include but are not limited to the following:
  • Defense strategies, information security policies, security plans, protection systems, access control measures, network systems architecture, security passwords, access codes, security procedures, processes, and recovery plans
  • Specific data collected in preparation of connection to the Department’s infrastructure or information essential to the Department’s information security
  • Security testing results, especially if the results identify specific system vulnerabilities

You must also agree and understand that this confidentiality provision’s purpose is to prevent public disclosure that may have an impact on public safety and security. Furthermore, you must also agree to indemnify, hold harmless, and defend the Nevada Department of Motor Vehicles (NV DMV) from all liability, claims, actions, damages, losses, and expenses.

Date

Enter the current date using the format: Day-Month-Year.

Signature of Applicant

Affix your signature.

Printed Name and Title of Applicant

Enter your full legal name and title if it is applicable.

Date of Signing

Enter the date of signing using the format: Day-Month-Year.

Printed Name of Notary Public or Authorized Nevada Department of Motor Vehicles (NV DMV) Representative

Have the notary public or authorized representative enter his or her full legal name.

Letter of Authorization to Release Information

Name of Applicant

Enter your full lega name.

Type of Information

Mark the appropriate box which corresponds to the type of information you have requested. You may select:

• Driver’s license - Enter your driver’s license number.
• Registration - Enter the vehicle identification number of your motor vehicle.
• Title - Enter the vehicle identification number of your motor vehicle.
• Vehicle Insurance Information - Enter the vehicle identification number of your motor vehicle.

Name

Enter the full legal name of the individual who will receive your information.

Mailing Address

Enter the mailing address of the individual who will receive your information.

Owner of Record

Signature

Affix your signature.

Date

Enter the current date.

Date of Signing

Enter the date of signing using the format: Day-Month-Year.

Printed Name of Notary Public or Authorized Nevada Department of Motor Vehicles (NV DMV) Representative

Have the notary public or authorized representative enter his or her full legal name.