DRIVER SERVICES — FIELD HEADQUARTERS
2701 S. DIRKSEN PKWY.
Office of the Secretary of State
SPRINGFIELD, IL 62723
217-782-7044
Driver Services Department
www.cyberdriveillinois.com
REQUEST TO REMOVE SUPPRESSED PERSONAL INFORMATION
Judicial Officer Name: _____________________________________ DL/ID Card #: _________________________________________
Judicial Title: ____________________________________Are you a Notary? : q YES q NO
I. Removal of Suppression of Personal Information:
I request to remove the suppression of personal information from the following records (include name of judicial officer and family
members residing with the judicial officer):
A. Driver’s License/ID Card:
Name Driver’s License/ID Card Number Date of Birth Gender
B. Vehicle Registration Information (List all applicable vehicles to remove suppression):
License Plate Number Vehicle Identification Number Vehicle Year & Make
Identification Presented: ________________________________________________________________
Signature of Judicial Officer: _________________________________________ Date:____________________________
Disclaimer: This request only applies to Secretary of State Information. Please consult the Administrative Office of the
Illinois Courts at 217-782-7770 to remove your request to suppress information held by other entities.
Secretary of State Facility Name and Number: ___________________________________________________________
Date Received/Faxed by Secretary of State: _____________________________________________________________
Fax Numbers: Driver Services: 217-558-5156 Vehicles Services: 217-785-4727 Index Department: 217-524-0930
Printed by authority of the State of Illinois. September 2012 — 1 — DSD A 276
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