REQUEST FOR INFORMATION - oregon.gov
ODL:DOB: Name:Address:City:State:Zip Code:735-7122 2 6)(Continued on next )STK# 300063 SECTION B. - I AM REQUESTING (For multiple inquires attach a separate sheet of paper with the below INFORMATION listed.)INSTRUCTIONS:DEPARTMENT OF TRANSPORTATIONDRIVER AND MOTOR VEHICLE SERVICES1905 LANA AVE NE, SALEM oregon 97314DMVREQUEST FOR INFORMATIONUnder oregon law, only certain requestors qualify to receive personal INFORMATION from DMV recordsand these requestors can only use the INFORMATION for specific purposes outlined in oregon s RecordPrivacy Law (ORS ). If INFORMATION is protected, it will not be released unless arequestor qualifies to receive the INFORMATION . As defined in oregon s Record Privacy Law, personalinformation means the following INFORMATION that identifies an individual:PRIVACY RULES & REGULATIONSACCESS TO DMV RECORDS IS HIGHLY RESTRICTED. IF YOU KNOWINGLY OBTAIN OR USEPERSONAL INFORMATION IN VIOLATION OF ORS ORS FROM A MOTORVEHICLE RECORD, YOU MAY BE SUBJECT TO CRIMINAL PROSECUTION OR A have read and understand the INFORMATION stated above and I understand I may be subject tocriminal and civil penalties if I misuse personal INFORMATION from oregon DMV License, Driver Permit or Identification Card NumberNameAddressTelephone Number REQUESTOR S SIGNATUREREQUESTOR S PRINTED NAMEDATEXNAME OF INDIVIDUAL, FIRM OR TRADE NAMEFAX NUMBERMAILING ADDRESSSTATEZIP CODE SECTION
(Continued on next page...) SECTION C. - TYPE OF RECORD REQUESTED 735-7122 (2- 6) Will personal information be provided to others? Explain in detail how you intend to use Oregon DMV records:_____
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