You have requested to obtain a Motor Vehicle Report

(driving record) from the

STATE OF ALASKA

Step 1. Please print this out

Step 2. Fill out the form COMPLETELY with a typewriter

Step 3. HAVE THE APPLICANT SIGN AND DATE the form

Step 4. Fax the completed form to I-NEX Solutions, Inc. at

fax (813) 968-2195

Step 5. The records can NOT be searched until the release form is received by I-NEX

Form on next page

STATE OF ALASKA
Sarah Palin, Governor

Department of Administration
Division of Motor Vehicles

*Driving Record Release Form*

I,_______________________________, do hereby authorize the Department of Administration, Division or Motor Vehicles, to release my Driving record to: ____________________________________________.

Signature: __________________________

Date______________________________

Alaska Drivers License #: ________________________

SSN#:_____________________________

Date of Birth_________________________

(Rev.-5 4/02) MUST BE TYPED!