Form Tc 96-16 - Request For Motor Vehicle Or Boat Record Which Includes Personal Information
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2KENTUCKY TRANSPORTATION CABINET
TC 96-16
Division of Motor Vehicle Licensing
Rev. 7/98
P.O. Box 2014
Frankfort, KY 40622
(502) 564-4076
REQUEST FOR MOTOR VEHICLE OR BOAT RECORD
WHICH INCLUDES PERSONAL INFORMATION
I hereby request the following information:
Title History
Current Owner
Other (specify)
_________________________________________________
On the following vehicle: VIN or HIN Number:
____________________________________________________________________
Title
License Plate
_____________________________________________
________________________________________________
Pursuant to the National Driver’s Protection Act, I certify that this release of information is permissible for the reason checked below (please
place initials beside box you checked) and will be used only as indicated. The undersigned takes full responsibility for any violations of this Act.
(Government agencies use reverse side of form)
___
For use by any private person or entity acting on behalf of a federal, state, or local agency in carrying out its functions.
___
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.
___
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 purpose of
preventing fraud by pursuing legal remedies against, or recovering on a debt or security interest against the individual.
___
For use in connection with any civil, criminal, administrative, or arbitral proceeding in any federal, state, or local 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 judgements and orders, or pursuant to an order of a federal, state, or local court.
___
For use in research activities, and for use in producing statistical reports, so long as the personal information is not published,
redisclosed, or used to contact individuals.
___
For use by any insurer or insurance support organization, or by a self-insured entity, or its agents, employees, or contractors, in
connection with claims investigation activities, antifraud activities, rating, or underwriting.
___
For use in providing notice to the owners of towed or impounded vehicles.
___
For use by any licensed investigative agency or licensed security service for any purpose permitted under this federal law.
___
For use by any requester, if the requester demonstrates he/she has obtained the written consent of the individual to whom the
information pertains.
______________________________________________________
_________________________________________________________
Printed name of Person Making Request
Signature
Date
______________________________________________________
Agency or Company (If applicable)
______________________________________________________
Address
______________________________________________________
STATE OF KENTUCKY
City
State
Zip Code
______________________________________________________
COUNTY OF _____________________________________________
Telephone Number
Signed and sworn before me this _____ day of ________, 20 ____.
FOR MOTOR VEHICLE LICENSING USE ONLY
________________________________________________________
Date Processed: __________________________________
Notary Public
Fees Collected: ___________________________________
My commission expires: _____________________________________
Clerk’s Initials: ____________________________________
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