REQUEST FOR DRIVING RECORD 419f Form PDf Alaska

REQUEST FOR DRIVING RECORD 419f Form, Driving Record Form pdf, Fillable Form Alaska Driving Record Request, Request a driving record application, Request a driving record By Mail,

Form 419F Rev 0 6 /202 3 www.alaska.gov/dmv State of Alaska – Division of Motor Vehicles REQUEST for DRIVING RECORD Driving Records can be requested via the DMV public website at: https://online.dmv.alaska.gov/onlinedrivingrecords Driving Records can also be requested in person at any DMV office or by mail, email, or fax. See below for contact information. There is a $10 fee for each type of record selected. There is no charge for Parents or Guardians requesting for a minor. Select the Type of Record:  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 a t - 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 status, full medical certification information, convictions, license actions, and at - fault accident information as required by DOT regulations for commercial (CDL) drivers. CDL drivers MUST select this type of record if for CDL emp loyment purposes. Please Print Clearly I am requesting this record:  For myself  For release to another person / company – by checking this box, I authorize the DMV to release my driving record to the following :  As a parent/guardian of a minor – by checking this box, I affirm I am a parent or legal guardian of a driver under 18 years - old (who is not emancipated) as listed in the next section. (Please Note: A ddresses will be redacted from driving records when choosing this option) Printed Name or Company Contact Phone Number Full Legal Name of Parent / Guardian Contact Phone Number Driver Information Full Legal Name on Driving Record Phone Number Alaska Driver’s License Number (or) Date of Birth AND Social Security Number  Please print copy of driving rec ord ( if an in - person transaction)  P lease send the driving record via: (select either email, fax, or mail ) email – include email address below fax – include fax number below mail – include mailing address below Signature of Requestor (or Parent/Guardian) Date (Valid for 90 days) Requests can be submitted by: (Please address to “DMV Research”) Payment can be made me check, money order, or credit card (submit separate credit card authorization form) Email: [email protected] M ail: 4001 Ingra Street Phone: 907 - 269 - 5551 Fax: 907 - 269 - 5202 Suite 101 Anchorage, Alaska 99503 This section is for DMV USE ONLY (optional use)  I have verified ID for an in - person request Name: ID #: Exp . Date: Batch Number: LDAP/Office #  $10 fee  No Fee Payment Total: CA CC CK F orm can also be hand deliver ed to any DMV office.