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COPY
RECORDS REQUEST
FOR ATTORNEY USE ONLY |
STATE OF CONNECTICUT
DEPARTMENT
OF MOTOR VEHICLES
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INSTRUCTIONS:
Please complete the section necessary for a copy of the last known address on
file at the Department of Motor Vehicles.
Please place a check next to the file or files from which you wish to receive
last known address information. You must include at least two identifying items
in each section requested. Section 1 requires driver's name plus driver's
license number or driver's date of birth. Section 2 requires owner's name plus
registration plate number.
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ATTORNEY E-MAIL ADDRESS
diby@jud.ct.gov
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ATTORNEY TELEPHONE NUMBER
860-999-9999
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SECTION 1 |
DRIVER'S NAME (Last, First, Middle Initial)
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DRIVER'S LICENSE NUMBER
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DRIVER'S ADDRESS (Number and Street, City or Town, State, Zip Code)
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DRIVER'S DATE OF BIRTH(mm/dd/yyyy)
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SECTION 2 |
OWNER'S NAME (Last, First, Middle Initial)
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OWNER'S ADDRESS (Number and Street, City or Town, State, Zip Code)
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REGISTRATION PLATE NUMBER
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DECLARATION: By entering my juris
number below I declare under the penalties of false statement as set forth in
Section 53a-157b of the Connecticut General Statutes that,
in accordance with Section 14-10 of the Connecticut General Statutes, I will use the
information obtained from motor vehicle records only in connection with any
civil, criminal, administrative or arbitral proceeding in any court or
government agency or before any self-regulating body, including the service of
process, an investigation in anticipation of litigation and the execution or
enforcement of judgments and orders.
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