MOTOR VEHICLE REQUEST FOR RECORDS

Form 303RM 0097 – SOK 03/2024

SECTION 1 – Information Requested Check type of record desired

Oklahoma Driving Record Summary

(State law limits this summary or Motor Vehicle Report (MVR) to three years.)

$25.00

TOTAL DUE

For certified copies, please add $3.00 per record to the amount due for a total of $28.00.

This report is for yourself:

Mailing Address: City: State: Zip:

SECTION 4 – Business, Organization, or Entity Information All information required

Name of Business, Organization, or Entity: Requestor’s Title: Type of Business:

SECTION 5 – Reason for Request Check all that apply (If none apply, complete Section 6)

Affirmation

Pursuant to 12 O.S. § 426, I state under the penalty of perjury that the requested information is being solicited solely for the reason(s) checked above or at the consent

of the named person. I understand the personal information furnished is confidential under Federal and State laws and is being released to me only for the reason

I have indicated above or at the consent of the named person, and that it is unlawful for me to furnish the information to any unauthorized person or entity or to be

used for any unauthorized purpose and if I release any of such information to another authorized person, I understand that I must inform that person of their duties

and responsibilities under the Drivers Privacy Protection Act [21 U.S.C. §§ 2421, et seq.] and their obligations to use such information only of the purposes set out therein

and their civil and criminal liabilities if they violate these duties, and their obligation to inform subsequent authorized recipients of said information of their identical

obligations and duties. I further agree to indemnify and held harmless both the Service Oklahoma and OK.gov from all liability and penalties associated with me or my

successor’ or assignees’ wrongful use and/or release of such information.

Requestor Signature: Date:

Form 303RM 0097 – SOK 03/2024