Fillable STATE OF ALASKA DIVISION OF MOTOR VEHICLES REQUEST (York College of Pennsylvania)

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STATE OF ALASKA DIVISION OF MOTOR VEHICLES REQUEST (York College of Pennsylvania)

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STATE OF ALASKA
DIVISION OF MOTOR VEHICLES
REQUEST FOR DRIVING RECORD BY MAIL
Form 419F Rev. 3/2018 www.alaska.gov/dmv
There is a $10 fee for each type of driving record selected. PLEASE PRINT CLEARLY.
SELECT RECORD TYPE:
FULL INDIVIDUAL RECORD
Shows current driving record status, and includes all convictions, license actions, and at-fault
accidents on record; includes full medical certification details for commercial (CDL) drivers.
INSURANCE RECORD
Shows current driving record status, and 3 or 5 year history of convictions, license actions, and at-fault accidents required for vehicle insurance
purposes; excludes any medical certification information on record. (3 or 5 year reporting requirement is based on the type of conviction or action.)
CDL EMPLOYMENT RECORD
Shows current driving record status; full medical certification information; and conviction, license action, and at-fault accident information as
required by DOT regulations for commercial (CDL) drivers. CDL drivers must select this type of record when used for CDL employment purposes.
REQUESTOR INFORMATION
Requestor Name
Phone Number
Alaska Driver License Number
OR
Date of Birth
AND
Social Security Number
RELEASE TO ANOTHER PERSON OR COMPANY (OPTIONAL)
By initialing this box I authorize the DMV to release my driving record to the person or company listed below:
Printed Name
Contact Phone Number
I WANT MY RECORD TO BE SENT VIA: Email Fax Mail (Select only one)
Email Address
Fax Number
Mailing Address
Signature of Requestor
Date (Valid for 90 days)
PAYMENT INFORMATION – Credit card info may be submitted via phone or postal mail only. Please DO NOT email or fax this
information. Requests will be held for 3 days. If payment information has not been received by that time the request will be discarded
Make check or money order payable to DMV or State of Alaska. DO NOT MAIL CASH.
MasterCard or Visa #
Expiration Date
Name as shown on card
Security Code (3 digit code on back of card)
I understand that my credit card will be charged $10 for each driving record.
Signature of credit card holder
Date
(Valid for 90 days)
DMV USE ONLY
Expiration Date:
BATCH
LOGIN ID / OFFICE
$10
FEE: CA CC CK
Submit request to DMV Research:
1300 W. Benson Blvd., Suite 410
Anchorage, AK 99503
Phone: 907-269-3754
Email: doa.dmv.research@alaska.gov
Fax: (907) 269-5202
Insperity Employment Screening
800-324-5664
866-334-9996
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STATE OF ALASKA DIVISION OF MOTOR VEHICLES REQUEST (York College of Pennsylvania)

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Completed 25 July 2020

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