Check the box next to each type of record that you want and provide as much search information as possible in Step . 3Provide the name and address of where to send the record(s) in Step .Provide your name and address in Step . 2Have one or more of the permissible uses described in Step . Check all of the permissible uses that apply and sign the certification . 5 INSTRUCTIONS FOR ORDERING YOUR OWN DMV RECORDMAIL YOURcompleted MV-15 form, payment, and identification to: NYS DEPARTMENT OF MOTOR VEHICLES, MV-15 PROCESSING, 6 EMPIRE STATE PLAZA, ALBANYPAGE 1 0F 3 MV-15 (/18) Print/Type name and mailing address where therecords will be mailedYour return receipt Name Address1Address2City, State, Zip TOTAL FEENo record ABS HIS TCK SUS APP INSAbstract(s) Life Stnd Reg Ttl Application Ticket(s)/Disposition(s) Suspensions/Revocations Lic RegInsurance Search Activity Report DMV OFFICE USE ONLY DONOTSTAPLEAmount Received$ 1 1 1 2 3 4 5 5 4Provide your name, address and signature in Step .Include a photocopy of your driver license or government-issued identification card with this request form or have yoursignature notarized in Step . 5Include a photocopy of your driver license or government-issued identification card with this request form or have yoursignature notarized in Step .Check the box next to each type of record that you want and provide as much search information as possible in Step .Enclose an acceptable form of payment according to the instructions in Step . NOTE: Sometimes, title (vin) abstracts may contain the names of other individuals, so you must check one or more of the permissible usesthat are listed and sign the certification in Step . To order another person220s DMV002record, use this checklist to complete all of the requirements listed below. You must:STEPINSTRUCTIONS FOR ORDERING ANOTHER PERSON220S DMV RECORD002002 $$American LegalNet, Inc. www.FormsWorkFlow.com DRIVING ABSTRACT (displays records for the last 4 years). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DRIVING RECORD HISTORY (referred to as215LIFETIME ABSTRACT216) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DMV can only provide this type of abstract to the individual whose name is on the record. Examples of when this maybe required include: background checks, bar exam, applicants for a license in U.S. or Canada, and an attorneyreviewing client220s entire record.Note - this history does not always include information that dates back to when a person was originally granted drivingprivileges. Some information is purged, as required by law.If your lawyer, court personnel or someone other than YOU002is requesting your Lifetime abstract, they must include form MV-15GC. Go to dmv.ny.gov to get the form.ADDRESS HISTORY(only your own address history). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DRIVER LICENSE REVOCATION/SUSPENSION ORDER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TICKET DISPOSITION* (includes photocopy of ticket or copy of electronic record). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LAST NAMEMAILING ADDRESS (INCLUDE STREET & NO.)APT #CITYSTATEZIP CODETICKET NUMBER of SUSPENSION ORDER NUMBERDATE OF VIOLATIONOFFENSEFIRSTM.I.DATE OF BIRTHSEXN.Y. DRIVER OR NON-DRIVER ID # SIGNATURE MV-15 (/18) PAGE 2 0F 3Check here if the mailing address you provided in Step 1 isdifferent from the requestor220s address.LICENSE 2STEP 3STEP REQUESTOR220S INFORMATIONCHECK THE BOX NEXT TO EACH TYPE OF RECORD THAT YOU WANT (SEARCH INFORMATION REQUIRED) 4STEP PAYMENT METHOD - DO NOT SEND CASHIF YOU WANT MORE THAN ONE TICKET, DISPOSITION, OR SUSPENSION ORDER, PLEASE ATTACH A LIST AND INCLUDE $10 FOR EACH ONE INSURANCE INFORMATION SEARCH/ACTIVITY REPORT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LAST NAMEPLATEYEARMAKEMODELVIN #FIRSTORM.I.DATE OF BIRTH REGISTRATION / OWNERIF YOU WANT MORE THAN ONE PLATE, VIN ABSTRACT OR SUSPENSION ORDER, PLEASE ATTACH A LIST AND INCLUDE $10 FOR EACH ONE Exempt 002Make checks payable to the 215Commissioner of Motor Vehicles216002Please remember to SIGN002YOUR CHECK002No starter checks002US Funds onlyLAST NAMEADDRESS WHERE YOU GET YOUR MAIL (INCLUDE STREET & NO.)APT #ZIP CODECITYSTATEFIRSTM.I. DAYTIME PHONE NUMBER (REQUIRED): 002X002002002002002002002002002x $10 each= $x $10 each= $x $10 each= $x $10 each= $x $10 each= $If crash/accident related, please include date of crash/accident 002LIST OF AN INDIVIDUAL220S CURRENT AND PREVIOUS VEHICLE REGISTRATION (PLATES) (if available). . . . . . . . . . . VEHICLE REGISTRATION (PLATE) ABSTRACT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 002VEHICLE REGISTRATION SUSPENSION ORDER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VEHICLE TITLE (VIN) ABSTRACT (Owner - only includes active lien information). . . . . . . . . . . . . . . . . . . . . . . . . . . . # of copies Fee Total # of copies Fee Total TOTAL DUE$Please calculate the total for each of the items you want and enter the total here ****DMV does not retain parking tickets - contact city, town or village*Provide as much search information as you know about the record(s) you are requesting.Provide as much search information as you know about the record(s) you are requesting. x $10 each= $ x $10 each= $x $10 each= $x $10 each= $x $10 each= $ Check MoneyOrderDMV Dial-in account number American LegalNet, Inc. www.FormsWorkFlow.com YOU MUST ATTACH A COPY OF YOUR ID.I certifythat I have read the Drivers Privacy Protection Act (18 U.S.C. Sec 2721 et seq.) and will comply fully with the terms of such law. I alsoagree to defend, hold harmless and indemnify DMV from all actions brought against DMV, or damages alleged against DMV, for my negligent,improper or unauthorized use or dissemination of the information provided by the DMV. SignaturePrint Name MV-15 (/18) PAGE 3 0F 3Date:1.Use in any civil, criminal, administrative, or arbitral proceeding in any court or agency, including the service of process, investigation inanticipation of litigation, and the execution or enforcement of judgments and orders or pursuant to a court order. (18 U.S.C. 2472721 (b)(4))2.Use by an insurer or insurance support organization or self-insured entity in claims investigations, anti-fraud activities, rating orunderwriting activities. (18 U.S.C. 2472721 (b)(6))3.Use in providing notice to the owners of towed or impounded vehicles. (18 U.S.C. 2472721 (b)(7))4.Use by an employer, its agent or insurer to obtain information relating to the holder of a commercial driver's license required underChapter 313 of Title 49 of the U.S.C. (18 U.S.C. 2472721 (b)(9))5.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, orcontractors; (18 U.S.C. 2472721 (b)(3)(A)) and(B)if such information as so submitted is not correct or is no longer correct, to obtain the correct information, but only for thepurposes of preventing fraud by, pursuing legal remedies against, or recovering on a debt or security interest against, theindividual. (18 U.S.C. 2472721 (b)(3)(B))6.Use required under NYS Vehicle and Traffic Law, Article 19A - Special Requirements for Bus Drivers. (18 U.S.C. 2472721 (b)(14))7.Use required under NYS Vehicle and Traffic Law, Article 19B - Special Requirements for Commercial Motor Carriers.(18 U.S.C. 2472721 (b)(14))8.Use by any government agency, including any court or law enforcement agency, in carrying out its functions. (18 U.S.C. 2472721 (b)(1))9.Use by any private person or entity acting on behalf of a federal, state, or local agency in carrying out its functions.(18 U.S.C. 2472721 (b)(1))10.Use in matters of motor vehicle or driver safety. (18 U.S.C. 2472721 (b)(2))11.Use in matters of motor vehicle theft.