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DMV DMV SERVICES 1905 LANA AVE NE SALEM OR 97314-2340 DEPARTMENT OF TRANSPORTATION DRIVER AND MOTOR VEHICLE SERVICES 1905 LANA AVE NE, SALEM OREGON 97314 k PRE-ADDRESSED -- FOLD AND MAIL IN STANDARD #10 WINDOW ENVELOPE REQUEST FOR DRIVING RECORD* *This form can ONLY be used by DMV account holders. If you do not have a Records Inquiry Account with DMV, please use DMV form titled Order Your Own Record (form number 735-7266). REQUESTOR’S DMV ACCOUNT NUMBER DR DATE OF REQUEST CS NON-EMPLOYMENT DRIVING RECORD = 3 -YEAR RECORD - $1.50 SUSPENSION PACKAGE - $11.50 COURT DATE: ______________________________ DE EMPLOYMENT DRIVING RECORD = 3 -YEAR RECORD - $2.00 ARS AUTOMATED REPORTING SYSTEM - $2.00 ADD DELETE DI DRIVER ADDRESS INFORMATION - $1.50 DO OPEN-ENDED NON-EMPLOYMENT DRIVING RECORD - $1.50 (Only available to insurers and insurance support organizations) CP CERTIFIED COURT PRINT = THIS OPTION MAY INCLUDE MORE THAN FIVE YEARS OF RECORD INFORMATION. - $3.00 PA POLICE TRAFFIC CRASH REPORT RECORD - $8.50 (For PA Requests see important information below.) MQ CERTIFIED COURT PRINT with CDL MEDICAL CERTIFICATION INFORMATION = MAY INCLUDE MORE THAN FIVE YEARS OF RECORD INFORMATION. - $3.00 ODL / CUSTOMER NUMBER DATE OF BIRTH (MONTH-DAY-YEAR) OTHER (Specify): ____________________________ NOTE: See DMV form # 735-6691 for additional record types DRIVER’S NAME (LAST, FIRST, MIDDLE) – FOR SUSP. PACKAGE (CS) ONLY – ARREST DATE 1 2 3 4 5 6 7 8 9 10 An $8.50 fee will be charged even when the DMV Police Traffic Crash Report can not be found. If the information below is not provided, your request will not be processed and returned back to you. For Accident Information Letters, you must attach a statement of representation and how your client was involved. Requests for police reports regarding automobile accidents must contain the following information: Date of Accident: _____________________ County (or nearest city if county unknown): ________________________________ Driver Information (name, date of birth, Oregon license number if available): ________________________ RETURN INFORMATION BY: ATTENTION FAX # MAIL COMPANY NAME: COMPANY ( ) STREET ADDRESS CITY, STATE, ZIP CODE 735-48 (11-15) Please Note: If more than 30 records are requested during one business day, your records will automatically be mailed to the mailing address associated with your account.
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