Florida Highway Safety & Motor Vehicles
Criminal Justice Agency Information Request Form
Email this completed form to LERequests@FLHSMV.GOV
*** Fields in RED are REQUIRED in order to properly process your request. ***
Requestor Name/Position:
Requestor Phone Number:
Supervisor Name/Position:
Supervisor Phone Number:
Agency Name:
Agency Address/ Phone Number:
*** DRIVER OR REGISTERED OWNER INFORMATION ***
Driver’s License/ ID Card Number:
Last 4 Social Security #:
Date of Birth:
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DL Supporting Application
Documents
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*** VEHICLE/ VESSEL INFORMATION ***
Title #:
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☐ Title History
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Tag/ Registration History
☐ Lienholder Information
☐ Current Tag/Registration
☐ Current Title
*** ADDITIONAL INFORMATION & NOTES REGARDING REQUEST ***
Records will be sent via U.S. mail, to the address you list on the top portion of the form. Please check this box if
the records need to be certified:
Attestation Statement:
“By signing below, I affirm that all the information I have provided is truthful and the information I am requesting is to be
used for official law enforcement purposes only. I understand that this request and the resulting information are subject to
the provisions of Chapter 119, Florida Statutes, and may be disclosed upon request unless prohibited by law.”
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Requestor’s Signature
HSMV 73209 (Revised 03/19)
Requestor’s Supervisor’s Signature
(Full or Partial)
(Full or Partial)
Your Agency Case Number:
Tag/Registration #:
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