Stae form 53789 2013-2026

1. Click ‘Get Form’ to open it in the editor.
2. In Step 1, provide your name, telephone number, email address, mailing address, and the last four digits of your Social Security number. This information is crucial for security purposes.
3. Move to Step 2 where you will enter the details of the person whose records you are requesting. Include their name, driver's license number (if known), last four digits of their Social Security number (if known), date of birth, and mailing address.
4. In Step 3, select the type of record you are requesting. Options include Certified Driver Record or Proof of Insurance. Be sure to specify any additional documents needed.
5. Step 4 requires you to indicate your qualification for receiving personal information. Choose one category and provide necessary identification if applicable.
6. Fill in the total amount owed in Step 5, then sign and date the form to affirm that all information is accurate.
7. Finally, mail this form along with payment to the Indiana Bureau of Motor Vehicles as indicated in Step 6.

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