A Public Service Agency                                                                                                   ...
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inf1125

  1. 1. A Public Service Agency A Public Service Agency REQUEST FOR YOUR OWN REQUEST FOR YOUR OWN DRIVER LICENSE/IDENTIFICATION CARD (DL/ID) DRIVER LICENSE/IDENTIFICATION CARD (DL/ID) OR OR VEHICLE/VESSEL REGISTRATION (VR) INFORMATION RECORD VEHICLE/VESSEL REGISTRATION (VR) INFORMATION RECORD FEE: $5.00 FOR EACH CURRENT RECORD FEE: $5.00 FOR EACH CURRENT RECORD Write your DL/ID number or plate or VIN on the front or the back of your check. Write your DL/ID number or plate or VIN on the front or the back of your check. DO NOT COMPLETE THIS FORM UNLESS YOU ARE REQUESTING YOUR OWN DL/ID RECORD DO NOT COMPLETE THIS FORM UNLESS YOU ARE REQUESTING YOUR OWN DL/ID RECORD OR YOU ARE THE CURRENT VR REGISTERED OWNER ON FILE WITH THE DEPARTMENT. OR YOU ARE THE CURRENT VR REGISTERED OWNER ON FILE WITH THE DEPARTMENT. PLEASE PRINT CLEARLY REQUESTER’S INFORMATION PLEASE PRINT CLEARLY REQUESTER’S INFORMATION FULL LEGAL NAME (FIRST, MI, LAST) FULL LEGAL NAME (FIRST, MI, LAST) ADDRESS ADDRESS CUT ON LINE AND KEEP THIS PART FOR YOUR RECORDS CITY STATE ZIP CODE CITY STATE ZIP CODE DAYTIME TELEPHONE DAYTIME TELEPHONE ( ) ( ) SIGNATURE DATE SIGNATURE DATE X X Check box(es) for type of record(s) you are requesting. Check box(es) for type of record(s) you are requesting. DRIVER LICENSE/ID RECORD DRIVER LICENSE/ID RECORD VEHICLE/VESSEL REGISTRATION VEHICLE/VESSEL REGISTRATION (Complete boxes A & B ) (Complete boxes A & B ) RECORD (Complete boxes C & D) RECORD (Complete boxes C & D) A. CALIF. DRIVER LICENSE/ID NUMBER C. CALIF. LICENSE/CF NUMBER A. CALIF. DRIVER LICENSE/ID NUMBER C. CALIF. LICENSE/CF NUMBER B. BIRTH DATE (MO/DAY/YR) D. VEHICLE/VESSEL ID NUMBER B. BIRTH DATE (MO/DAY/YR) D. VEHICLE/VESSEL ID NUMBER DMV USE ONLY DMV USE ONLY ID Verified by Cashier Line Date ID Verified by Cashier Line Date This request may be presented in person to your local DMV office or mailed to DMV This request may be presented in person to your local DMV office or mailed to DMV Headquarters: Headquarters: Department of Motor Vehicles Department of Motor Vehicles P. O. Box 944247 MS G199 P. O. Box 944247 MS G199 Sacramento, CA 94244-2470 Sacramento, CA 94244-2470 INF 1125 (REV. 11/2000) WWW INF 1125 (REV. 11/2000) WWW Complete if mailing. Complete if mailing. Send information to: (Print your name and address clearly in the box.) Send information to: (Print your name and address clearly in the box.) NAME NAME ADDRESS ADDRESS CITY STATE ZIP CODE CITY STATE ZIP CODE — También disponible en español — — También disponible en español — INF 1125 (REV. 11/2000) WWW INF 1125 (REV. 11/2000) WWW Clear Form Print
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