Fillable Form New York Driver Record Request (MV-15C)

What is the New York Request for Driving Record Information form?

Form MV-15C or the New York Request for Driving Record Information form is a New York Department of Motor Vehicles (DMV) form exclusive to holders of a New York driver’s license used to obtain their driving record.

Your New York driving record contains the status of your driver’s license, convictions, suspensions, revocations, accidents, and accident prevention course completion. It shows whether your license has been suspended or revoked and records traffic tickets and fines you received. While driving records typically show some personal information, such as legal name and birth date, social security numbers are not recorded in the state of New York.

You can use the New york Request for Driving Record Information form to request your or another person’s record.

When submitting this form, you need to show documents to prove your identity. In addition, the Vehicle and Traffic Law requires that DMV charge a $10 search fee. Even if the record is not found, you still have to pay the fee. If the DMV is not able to find the record with the information you provided, it will send you a written notification to advise you that the requested record was not found.

How to fill out the New York Request for Driving Record Information form?

The New York Request for Driving Record Information form is a two-page document. A separate form must be used for each search requested.

Provide all the information required correctly to avoid any problems. In addition, deliberately making any false statements or concealing a material fact in the form is a criminal offense, punishable by the law. If you make any false representation to get any personal information from an individual’s Motor Vehicles records, will be subject to federal criminal fines.

Page 1

Select “I request my own record” or “I request another person’s record.” If you select the former, complete Section A only. If you select the latter, complete Section A and Section B, then write your initials next to the “permissible use” that applies to your request on Page 2.

A. Information about the driver record you request

Driver License ID#

Enter your driver’s license identification number.

Name

Enter your full legal name in the following format: Last, First, Middle.

Date of Birth

Enter your date of birth in the following format: Month, Day, Year.

Sex

Mark M for male or F for female.

B. Your Information

Name

Enter your full legal name in the following format: Last, First, Middle.

Date of Birth

Enter your date of birth in the following format: Month, Day, Year.

Sex

Mark M for male or F for female.

Address

Enter your full address, including street, apartment number, city or town, state, and ZIP code.

Sign Here

Provide your signature.

Date

Enter the date you signed the form.

Credit Card Authorization

Sign Here

Provide your signature. By doing so, you authorize the use of your credit card for payment of any fees in connection with the request and understand that you must be present for the transaction.

Cardholder-Sign Name in Full

Enter your full legal name.

Date

Enter the date you signed the form.

Page 2

List of Permissible Uses

Check the items that apply:

1. Use in any civil, criminal, administrative, or arbitral proceeding in any court or agency, including the service of process, investigation in anticipation of litigation, and the execution or enforcement of judgments and orders or pursuant to a court order.

2. Use by an insurer or insurance support organization or self-insured entity in claims investigations, anti-fraud activities, rating or underwriting activities.

3. Use in providing notice to the owners of towed or impounded vehicles.

4. Use by an employer, its agent or insurer to obtain information relating to the holder of a commercial driver’s license required under Chapter 3 13 of title 49 of the U.S.C.

5. For use in the normal course of business by a legitimate business or its agents, employees, or contractors, but only-

a. to verify the accuracy of personal information submitted by the individual to the business or its agents, employees, or contractors; and

b. if such information as so submitted is not correct or is no longer correct, to obtain the correct information, but only for the purposes of preventing fraud by, pursuing legal remedies against, or recovering on a debt or security interest against, the individual.

6. Use required under NYS Vehicle and Traffic Law, Article 19A - Special Requirements for Bus Drivers.

7. Use required under NYS Vehicle and Traffic Law, Article 19B - Special Requirements for Commercial Motor Carriers.

8. Use by any government agency in carrying out its functions.

9. Use by any private person or entity acting on behalf of a federal, state, or local agency in carrying out its functions.

10. Use in matters of motor vehicle or driver safety.

11. Use in matters of motor vehicle theft.

12. Use in matters of motor vehicle emissions

13. Use in matters of motor vehicle product alterations, recalls or advisories.

14. Use in performance monitoring of motor vehicles, motor vehicle parts and dealers.

15. Use in motor vehicle market research activities, including survey research.

16. Use in removal of non-owner records from the original owner records of motor vehicle manufacturers.

17. Use in the operation of private toll transportation facilities.

18. For use by any requester, if the requester demonstrates it has obtained the written consent of the individual to whom the information pertains. (May use form MV-15GC).

19. Use specifically authorized under NYS law, IF such use is related to the operation of a motor vehicle or public safety.Cite the specific NYS law in the space provided.

20. Use in research activities and in producing statistical reports, as long as the personal information is not published, disclosed or used to contact individuals.