DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
REQUEST FOR DISCLOSURE OF PERSONAL INFORMATION
The Driver Privacy Protection Act, 18 United States Code, Sections 2721-2725 (DPPA), exempts personal information
contained in motor vehicle or driver license records from disclosure except to individuals/companies which qualify
under any of the 15 exceptions outlined therein. Personal information includes social security number, driver
license/identification (ID) card number, name, address, telephone number and medical or disability information.
By completing this form, you are requesting that personal information contained in your motor vehicle or
driver license/ID card records be released. To request that your personal information be disclosed to
requesters, you must provide your driver license/ID card number, and/or the title/license plate number for each
vehicle for which you are a listed owner.
To correctly identify your records, the information you provide must match our department files. Please carefully
copy your Florida driver license/ID card number and date of birth directly from your driver license/ID card. For each
motor vehicle titled/registered in your name, copy the title/license plate number and the date of birth directly from the
Florida vehicle registration certificate. If you have vehicles registered with a different birth date, submit a separate
form for each birth date. If we cannot find a match in our files from the numbers you provided, we will notify you at
the address you provided. Be sure to sign and date this form.
PLEASE RELEASE THE PERSONAL INFORMATION FROM MY DRIVER LICENSE/ID CARD AND/OR
MOTOR VEHICLE RECORD(S)
DRIVER LICENSE/ID CARD NUMBER
LICENSE PLATE NUMBER
__ __ __ __ __ __ __ __ __ __ __ __ __
Vehicle 1 __ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __
Vehicle 2 __ __ __ __ __ __