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Motor Vehicle And Fleet Management Best Practice Guidelines

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___ For use in connection with any civil, criminal or administrative proceeding in any federal,state or local court or agency for service of process or enforcement of judgments.___ For use in research activities so long as the personal information is not published,redisclosed or used to contact the individual.___ For use by an insurance company for claims investigation, rating or underwriting.___ For use in notifying owners of towed or impounded vehicles___ For use by any licensed private investigator for any purpose permitted under the DPPA.___ For use by an employer to obtain or verify information relating to the holder of a commercialdriver license.___ For use in connection with the operation of private toll transportation facilities.___ For any other use authorized by state law, if the use relates to motor vehicle operation orpublic safety.I understand the personal information furnished is confidential under Federal and State law andis being released to me only for the reason I have indicated above and that it is unlawful for meto furnish the information to an unauthorized person or entity.Printed Name of Individual: ________________________________Signature: ____________________________ Date: ___________RepresentingPrinted Name of Company: _________________________________Address: ___________________________________________________________________City: _________________ State: ____________ Zip:__________You may mail the form with an $11.00 money order per request to: Department of Public SafetyAttn: MVR1900 E. Woodrow WilsonDPPA-3 Jackson, MS 39216<strong>Motor</strong> <strong>Vehicle</strong> and <strong>Fleet</strong> <strong>Management</strong> <strong>Best</strong> <strong>Practice</strong> <strong>Guidelines</strong> 21

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