Request For Motor Vehicle Information printable pdf download

MVR-605A (Rev. 01/16)

North Carolina Division of Motor Vehicles

Request for Motor Vehicle Information

The Federal Driver’s Privacy Protection Act requires that personal information in DMV records be closed

to the public. Personal information from these records may be released to individuals or organizations

that qualify under one of the fourteen exceptions listed on the back of this form

I REQUEST CERTIFIED COPY OF COMPLETE TITLE HISTORY

I REQUEST CERTIFIED COPY OF PARTIAL TITLE HISTORY

I REQUEST AN IDENTIFICATION OF THE FOLLOWING

(Check applicable block below)

License number:______________________________________________________________

Identification number: _________________________________________________________

Name (Full Name Registered) ___________________________________________________

Name of Insurance Company ___________________________________________________

Insurance Policy Number ______________________________________________________

I am qualified to obtain this information under exception number________ listed on reverse side.

I understand that I may not redisclose this information except as provided by statute._______________

(Requester Must Initial)

Reason for Identification:

_________________________________________________________________________________

NOTE: Improper release of this information and/or false representation to gain information are prohibited

acts under both state and federal law. (Class 2 misdemeanor G.S.20-43.1).

Requested by:

Signature: _________________________________________________________________________

(First)

(Middle)

(Last)

Address: __________________________________________________________________________

(Street)

_________________________________________________________________________________

(City)

(State)

(Zip Code)

Telephone: ________________________________________________________________________

Driver License Number: ___________________ Date: _____________________________________

Vehicle Information - $1.00 fee. Mail form & fee to N.C. Division of Motor Vehicles RTP Unit,

3148 Mail Service Center, Raleigh, NC 27699-3148

Certified Copies - $13.00 fee.

Mail form & fee to N.C. Division of Motor Vehicles, Room 100,

3157 Mail Service Center, Raleigh, NC 27699-3157

(SEE REVERSE SIDE)

Request For Motor Vehicle Information