Pdf request for motor vehicle record official record of

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Title: 1_1_DL 49 May 05-1_.doc
Author: kstamegna
Creator: Microsoft Word - 1_1_DL 49 May 05-1_.doc
Producer: Acrobat PDFWriter 5.0 for Windows NT
CreationDate: Wed Jun 29 15:06:47 2005
ModDate: Wed Jun 29 15:09:51 2005
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Pages: 1
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Page size: 612 x 792 pts (letter) (rotated 0 degrees)
File size: 8592 bytes
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PDF version: 1.2

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PDF Abandoned Motor Vehicle Record Request

North Carolina Division of Motor Vehicles
Driver License Section
Request for Motor Vehicle Record
Official Record of Convictions for Violations of
Motor Vehicle Laws and Departmental Action
Please type or print clearly
I am hereby requesting the Motor Vehicle Record (MVR) of the below listed person:
Name ______________________________________________________ Sex _______ Race _______ Date of Birth ___________________
(First) (Middle or Maiden) (Last)
______________________________________________________ , _______________________________________ , ________________
(Street address) (City/Town) (State)
NC Driver License No. ______________________________ SSN or ITIN ________________________
Optional:
Copies of Suspension Orders are also requested.
Requested by: ________________________________________ Date: ___________________ Position: __________________________
Agency Name: _______________________________________________________ Phone No. __________________________________
Mailing OR State
Address: ______________________________________________________________________ Courier No. _______________________
City ________________________________________________ State __________________________ Zip Code ___________________
Mail this form to: NCDMV, Driver License Records, 3113 Mail Service Center, Raleigh, NC 27699
Form DL-49 Revised May 2005 previous editions are obsolete DO NOT USE

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