MOTOR VEHICLE
RECORDS
Pursuant to (RSA 260:14)
Division of Motor Vehicles
23 Hazen Drive, Concord, NH 03305
Registration
Title
Fax
(603) 227-4030
(603) 227-4150
(603) 271-1061(all areas)
(Rev. 05/16)
I. Requested Information: Are you requesting:
A. Your Motor Vehicle Record?
B. Another person’s Motor Vehicle
Record?
The back of this form must be completed and notarized by
the owner of the record.
C. Another person’s Motor Vehicle
Record as an authorized agent of your
employer or a company?
A Certificate of Authority must accompany this request, or one
must be on file with the Division of Motor Vehicles.
II. Requestor Information:
Name of Requestor: ____________________________________________________
Employer/Company
(If applicable): _______________________________________________
Address: ________________________________________Tele.#: ___________________
City: ___________________________________ State: __________ Zip: ______________
III. Requested Records:
Driver Record (Certified copy): $ 15.00
Driver Record (Non-Certified copy): $ 15.00
Driver Record (Insurance copy): $ 15.00
Registration Listing (Current Information Only): $ 5.00
Registration (Certified copy): $ 15.00
Title History Search (not a duplicate title): $ 20.00
License Applications and Letters of Verification: $ 15.00
Insurance Card (Accident use only): $ 1.00
Storage/Mechanics Lien (RSA 444:4-a): $ 0.00
Accident Report (Requestor will be notified if $ 5.00
cost
exceeds $5.00).
Other: _______________________________: $______
Make checks payable to “State of NH – DMV”
IV. Intended Use of Information:
IMPORTANT: To be completed only if you checked Box C above
For use in connection with any civil, criminal, administrative or arbitral proceeding.
Docket # _____________________ Court: ____________________[RSA 260:14 V (a)(2)].
By a bank or similar institution to verify the accuracy of personal information submitted by the
individual to the bank [RSA 260:14 V (a)(3)].
For providing notice to the owner(s) of a towed or impounded vehicle [RSA 260:14 V (a)(5)].
For use by any private investigative agency or security service licensed by this state for any
purpose permitted pursuant to RSA 260:14, V (a), other than for bulk distribution for surveys,
marketing or solicitations pursuant to RSA 260:14, V (a)(8) __________________________
[RSA 260:14 V (a)(6)].
Indicate specific reason here
By an employer or its agent or insurer to obtain or verify information relating to a holder of a
commercial driver’s license [RSA 260:14 V (a)(7)].
By a public utility to perform its public service obligation provided the individual has given
their express consent [RSA 260:14, V (a)(9)].
For an insurance company or by its authorized agent [RSA 260:14 IV (a)(2)].
Vehicle or boat information only.
For use by a life insurance company authorized to write life insurance policies in New
Hampshire, or its authorized agent. In checking off this box, I represent that the named
person’s written consent to the release of the record has been obtained and that the
record will be used solely in connection with claims investigation, rating, and
underwriting. ________________ [(RSA 260:14, V(a)(10)]
V. Search For (provide all applicable information):
Name:____________________________________________
Date of Birth: ______________________________________
Registration/Plate #: ________________________________
Driver License/I.D. #: ________________________________
Vehicle Identification #
: ______________________________
Last Known Address: ________________________________
__________________________________________________
Date of Accident: ____________________________________
Location of Accident: _________________________________
Route/Street City/Town
Other Identification Information:
____________________________________
***Reverse Side Must Be Completed Before Processing***
