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type of driving record selected.PLEASE PRINT CLEARLY.  \nSubmit request to DMV Research:  \n# SELECT RECORD TYPE:\n\n1300 W.Benson Blvd.,Suite 410  \nAnchorage,AK 99503  \n# □FULL INDIVIDUAL RECORD\n\nPhone:907-269-3754  \nShows current driving record statusand includes allconvictions,license actions,and at-fault  \nFax:907-269-5202  \naccidents on record;includes full medical certification details for commercial (CDL)drivers.  \nEmail:doa.dmv.research@alaska.gov  \n# □INSURANCE RECORD\n\nShows current driving record status,and 3 or 5year history of convictions,license actions,and at-fault acidents required for vehicle insurance  \npurposes;excludes any medical certifcation information on record.(3 or 5 year reporting requirement is based on the type of conviction or action.)  \n# CDL EMPLOYMENT RECORD\n\nShows curent driving record status;full medical cerifcation information;and conviction,license action,and at-fault accident information asrequired by DOT regulations for commercial (CDL)dnivers.CDL drivers must select this type of record when used for CDLemployment purposes.  \n\n| REQUESTOR INFORMATION   |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Requestor Name   |  |  |  |  | Phone Number   |  |  |  |  |\n| Alaska Driver License Number   |  | OR   |  | Date of Bith   |  | AND   |  | Social Security Number   |  |\n| RELEASE TO ANOTHER PERSON OR COMPANY (OPTIONAL)   |  |  |  |  |  |  |  |  |  |\n|  | By initialing this box l authorize the DMV to release my driving record to the person or company listed below:   |  |  |  |  |  |  |  |  |\n| Printed Name  \u003Cbr>Kenai Peninsula College   |  |  |  |  | Contact Phone Number  \u003Cbr>907-262-0308   |  |  |  |  |\n| I WANT MY RECORD TO BE SENT VIA:□Email □Fax □Mail(Select only one)   |  |  |  |  |  |  |  |  |  |\n| Email Address  \u003Cbr>Irnash@alaska.edu   |  |  |  |  | Fax Number  \u003Cbr>907-262-0322   |  |  |  |  |\n| Mailing Address  \u003Cbr>156 College Rd,Soldotna AK 99669   |  |  |  |  |  |  |  |  |  |\n| Signature of Requestor   |  |  |  |  | Date (Valid for 90 days)   |  |  |  |  |\n| PAYMENT INFORMATION   |  |  |  |  |  |  |  |  |  |\n| Make check or money order payable to DMV or State of Alaska.DO NOT MAIL CASH.   |  |  |  |  |  |  |  |  |  |\n| MasterCard or Visa\\#   |  |  |  |  |  |  | Expiration Date   |  |  |\n| Name as shown on card   |  |  |  |  |  |  | Security Code(3 digit code on back of card)   |  |  |\n| l understand that my credit card will be charged $10 for each driving record.   |  |  |  |  |  |  |  |  |  |\n| Signature of credit card holder   |  |  |  |  | Date (Valid for 90 days)   |  |  |  |  |\n| DMV USE ONLY   |  |  |  |  |  |  |  |  |  |\n| □Ihave verified ID for in-person request  \u003Cbr>Expiration Date:   |  |  | BATCH   |  | AMVC ID/OFFICE   |  |  |  | $10  \u003Cbr>FEE:  \u003Cbr>CA  \u003Cbr>CK  \u003Cbr>CC   |\n\nwww.alaska.gov/dmv","cbCailq1oS1WTgAq","https://ap.wps.com/l/cbCailq1oS1WTgAq","pdf",67052,"English","# Select Record Type\n## Full Individual Record\n## Insurance Record\n## CDL Employment Record\n# Requestor Information\n# Release Authorization (Optional)\n# Delivery Method\n# Payment Information\n# DMV Use Only","[{\"question\":\"What record types can be requested on this form?\",\"answer\":\"The form offers Full Individual Record, Insurance Record, and CDL Employment Record. Each type specifies different scope and reporting requirements.\"},{\"question\":\"How much is the fee for a driving record request?\",\"answer\":\"There is a $10 fee for each type of driving record selected.\"},{\"question\":\"How long is the submitted request valid?\",\"answer\":\"The signature date must be valid for 90 days.\"}]","STATE OF ALASKA - DIVISION OF MOTOR VEHICLES - REQUEST FOR DRIVING RECORD | PDF",1789872229]