MI BDVR-153 2008 free printable template

Fill out this form and send it in a U.S. mail or hand deliver your completed request form to Michigan Department of State Records, P.O. Box 14061, Lansing, MI 481, FAX:. For privacy reasons, if you are requesting a record for someone other than yourself, please let us know if we can obtain an electronic copy of your driving record. Please see the “Requesting Your Record” information above for possible options. If we agree to obtain an electronic record, we will forward an electronic copy of your driving record to: Michigan Department of State Records. P.O. Box 14061 Lansing, MI 481 If you are requesting your records for use in an educational application or program that is for distribution to the public, please provide the following information for the school or educational facility you are requesting documents for. Name of school Number of students in program Current or previous location of school location in Michigan School (e.g., the school building or school driveway) name of program or program coordinator Contact information for supervisor or program administrator Telephone numbers to contact program or program coordinator (e.g., to contact someone else in the program) Current or previous location of the school. If the school is not in Michigan, please indicate the state, if applicable. If you have more than one student enrolled in a course in the same department at a specific school location, please indicate the department and indicate whether they were enrolled in the same or similar program, and the location where these students were enrolled, as applicable. If your school is not in Michigan, please indicate the state, if applicable. Please note: If you are requesting information for use in a report or form of education, please fill out this form. If you are requesting information to be used for a specific educational or employment purpose, or if your purpose for requesting the record is different from these, please let us know. Current or previous address of the school or educational facility: Please print the following information. Title of report, document, form or activity (e.g., “Certified Copy of a Traffic Ticket,” “Exam Prepared for State Testing,” etc.) Address of record(BS) (Note: Do not enter the street address or any residential locations). (e.g.