Fillable Printable Audit Request Form
Fillable Printable Audit Request Form
Audit Request Form
Driver and Vehicle Services Data Request
Rev. 12/13
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
445 Minnesota Street, Ste. 191, Saint Paul, MN 55101-5191
Phone: (651) 201-7775 TTY: (651) 282-6555 Web: dvs.dps.mn.gov
Email: [email protected]
You are being asked to give your name for this data request to ensure the accuracy of any response to your
request. Your name, as a data requester, is public data. You are also being asked to provide your date of birth
and/or driver’s license number, email address and/or street address, which are private data. You are asked to
give your date of birth and/or driver’s license number to properly identify you for your request and to ensure
accuracy of the response. You are asked to provide your email address and/or street address to return your data
to you. You are not required to give your date of birth and/or driver’s license number, email address and/or street
address. However, if you do not provide your date of birth and/or driver’s license number, email address and/or
street address, DVS may have insufficient information to provide data responsive to your request. Your date of
birth and/or driver’s license number, email address and/or street address will be shared with Driver and Vehicle
Services staff as necessary to provide a response to your request.
Full Name
has queried my driver's license and/or motor vehicle records on the DVS database (ESupport).
I, , hereby request the data on file to who
Date of Birth
Driver's License Number
X
Signature
Date
Submit completed form via: Fax: (651) 797-1205
Email: [email protected]
Mail: DVS Data Services
License Plate Number(s)
By checking this box, I request that the above license plate number(s) be queried on the DVS database.
445 Minnesota Street, Ste. 191
Saint Paul, MN 55101-5191
(Month, Year)
From
Requested time frame of database query:
(Month, Year)
To
Return data via:
(Email address)
(Street address, City, State, Zip code)
Email
US Mail
(select one)
Print Form
