Get Form Dr 500 002

Date and place DR-500-002 R/6/12 WA Page 1 of 2 X When you have completed this form please print it out and sign here. Click here to START or CLEAR then hit the TAB button Address Request from Driver Record You can use this form to request an address of an individual who has a Washington driver license identification card or permit number. For validation only Include 2. 00 for each address up to ten and. 15 for each additional* Governmental agencies are exempt from the fee. 106-060-421-0005 Mail this completed request and your check or money order payable to the Department of Licensing to Driver Records PO Box 3907 Seattle WA 98124-3907 Information about the person whose address you are requesting PRINT or TYPE Name Last First Middle initial For additional names see page 2 or attach separate sheets Date of birth or driver license number Your information Name Last First Middle initial Company name Check here if government agency Area code Daytime telephone number Why do you need the address es and how will you use the information Attach a separate sheet if necessary. How do you want the information sent Check one fax to email to Answer the following Do you agree that the information provided except as provided for in 18 USC Section 2721 DPPA Chapter 42. 56 RCW and WAC 308-10-050 will not be divulged to any third party and will not be used for commercial purpose by any other individual or organization you represent. Yes No I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signature We are committed to providing equal access to our services. If you need accommodation please call 360 902-3900 or TTY 360 664-0116. Click here to START or CLEAR then hit the TAB button Address Request from Driver Record You can use this form to request an address of an individual who has a Washington driver license identification card or permit number. For validation only Include 2. 00 for each address up to ten and. 15 for each additional* Governmental agencies are exempt from the fee. For validation only Include 2. 00 for each address up to ten and. 15 for each additional* Governmental agencies are exempt from the fee. 106-060-421-0005 Mail this completed request and your check or money order payable to the Department of Licensing to Driver Records PO Box 3907 Seattle WA 98124-3907 Information about the person whose address you are requesting PRINT or TYPE Name Last First Middle initial For additional names see page 2 or attach separate sheets Date of birth or driver license number Your information Name Last First Middle initial Company name Check here if government agency Area code Daytime telephone number Why do you need the address es and how will you use the information Attach a separate sheet if necessary. 106-060-421-0005 Mail this completed request and your check or money order payable to the Department of Licensing to Driver Records PO Box 3907 Seattle WA 98124-3907 Information about the person whose address you are requesting PRINT or TYPE Name Last First Middle initial For additional names see page 2 or attach separate sheets Date of birth or driver license number Your information Name Last First Middle initial Company name Check here if government agency Area code Daytime telephone number Why do you need the address es and how will you use the information Attach a separate sheet if necessary. How do you want the information sent Check one fax to email to Answer the following Do you agree that the information provided except as provided for in 18 USC Section 2721 DPPA Chapter 42.