Updated August 1, 2012 Page 2 of 2
Permissible Uses of Private Data.
On the front of this form indicate the permissible use (found below) that allows you to obtain personal
information. Provide any additional information as required.
(1) For use by any government agency, including any court or law enforcement agency, in carrying out
its functions, or any private person or entity acting on behalf of a Federal, State, or local agency in
carrying out its functions.
(2) For use in connection with matters of vehicle or operator safety and theft; emissions; product
alterations, recalls, or advisories, and performance monitoring.
(3) For use in the normal course of business by a legitimate business or its agents, employees, or
contractors, in order to verify the accuracy of personal information submitted by an individual. If the
information as submitted is not correct or is no longer correct, correct information may be obtained
only for the purpose of preventing fraud by, pursuing legal remedies against, or recovering on a debt
or security interest against the individual. If the person requesting access is acting as the agent of a
lienholder, the requestor must submit proof of a contract with the lienholder.
(4) For use in connection with any civil, criminal, administrative, or arbitration proceedings in any
Federal, State, or local court or agency or before any self-regulatory body, including the service of
process, investigation in anticipation of litigation, and the execution or enforcement of judgments
and orders, or pursuant to an order of a Federal, State, or local court, provided that the requestor
provides a copy of the court order.
(5) For use by any insurer or insurance support organization, or by a self-insured entity, or its agents,
employees, or contractors, in connection with claims investigation activities or antifraud activities. If
agent of insurance company, requestor must provide insurance company name.
(6) For use in providing notice to the owners of towed or impounded recreational vehicles or watercraft.
The person requesting access must provide the name, address, and telephone number of the entity
that request that the recreational vehicle or watercraft be towed.
(7) For use by any licensed private investigative agency or licensed security service for any purpose
permitted under this section, provided that the person provides a copy of a valid license.
(8) Where the use is related to the physical safety or security or operators, vehicles, pedestrians, or
property.
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