Flint Hills Volunteer Center Authorization to Request Motor Vehicle Report

Request for Motor Vehicle Report (MVR)

I hereby request and authorize the Kansas Department of Motor Vehicles to furnish the below named company with my motor vehicle driving record. I voluntarily waive all right of recourse and release you from liability for compliance with this authorization.

Step 1 of 2

I hereby request and authorize the Kansas Department of Motor Vehicles to furnish the below named company with my motor vehicle driving record. I voluntarily waive all right of recourse and release you from liability for compliance with this authorization.*
I agree.
SECTION 1 – DRIVER INFORMATION
(must exactly match driving record)
Full Name*
First Middle Last
Birth Date*
Month
Day
Year
Driver's License #*
Driver's License Expiration Date*
Month
Day
Year
The Flint Hills Volunteer Center must be provided a copy of your current Drivers License.
You may provide this in person if you choose to do so. Applications cannot be approved until it is received.
Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 64 MB.

Request for Motor Vehicle Report (MVR)

Step 1 of 2

SECTION 1 – DRIVER INFORMATION

SECTION 2 – THIRD PARTY REQUESTOR INFORMATION

SECTION 3 – AUTHORIZATION TO RELEASE RECORD OF DRIVER