MVR Account No.__________

STATE OF ALASKA        TONY KNOWLES, GOVERNOR          

                             Department of Administration

                                             Division of Motor Vehicles

*DRIVING RECORD RELEASE FORM*

     I, ______________________________, do hereby authorize the

     Department of Administration, Division of Motor Vehicles, to release my

     driving record to: ___              ___________.

                                                           Signature: ___________________________

                                                           Date: ________________________________

                                                           Alaska Drivers License #: _______________

                                                             SSN#: ________________________________

 

                                                             Date of Birth: __________________________