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Notarized Authorization To Release Personal Motor Vehicle Information DO-21A - New Jersey

Notarized Authorization To Release Personal Motor Vehicle Information Form. This is a New Jersey form and can be used in Motor Vehicle Commission Statewide .
 Fillable pdf Last Modified 3/3/2010
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NOTARIZED AUTHORIZATION TO RELEASE PERSONAL MOTOR VEHICLE INFORMATION (Please Print) I, _________________________________, grant permission to __________________________________ to (Name of granter) (Name of recipient) receive my personal driver history record and any other personal motor vehicle information deemed appropriate for release under the "Drivers' Privacy Protection Act". Date_________________________ ________________________________________ (Signature of person granting release) #_________________________________ (DL number of person granting release) ____________________________________________________ Street Address ____________________________________________________ City State Zip On this ________ day of ______________ 20_______, ____________________________ personally appeared (Name of granter) before me and acknowledged that the foregoing authorization was approved and signed by him/her. ______________________________ Notary Public in and for the County of ____________________State ______________ My Commission expires _________________ This form, when properly completed and signed, will be accepted by the New Jersey Motor Vehicle Commission as satisfactory authorization to release personal motor vehicle information concerning the individual named above to the second party named above. THIS FORM WILL NOT BE ACCEPTED UNLESS IT IS ACKNOWLEDGED BY A NOTARY PUBLIC OR ATTORNEY AT LAW BGS/DO-21A (R4/08) American LegalNet, Inc.
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