ASVAC CONSENT TO RELEASE MOTOR VEHICLE RECORD

CONSENT TO RELEASE MOTOR VEHICLE RECORD

ONE TIME VALIDITY
Date

MonthDayYear
Date
PERSONAL INFORMATION TYPE:
The release of information from the Department of Motor Vehicles (DMV) is governed by Va.Code §§46.2‑208 through 214. This statute stipulates that all DMV records are privileged and are not available to the general public. DMV may only release driver,vehicle and personal information from our records under a written consent from the driver himself.

I consent to the MVR agency obtaining and releasing my driver license information to the organisation shown above.
NAME:
(first,middle,last,suffix)
DRIVER LICENSE NUMBER
DATE OF BIRTH

MonthDayYear
Date of birth
SIGNATURE
PLEASE UPLOAD A COPY OF YOUR CURRENT DRIVER LICENSE FOR OUR RECORDS

Cancelof
Should be Empty: