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STATE OF ALASKAREQUEST FOR DRIVING RECORDDriving records are valid for 30 days. am requesting the following: Driving Record (5 year / Insurance) Driving Record (Fullwould like the record to be mailed or faxed (circle one) to the address or fax number shown below. Your ames shown on your Alaska license Your ignature Telephone Fax Mailing ddress ALASKA Driver License Number Date of Birth AND Social Security Number Purpose of record: Please complete the following when requesting information viafax. If your request is made by mail, include a check or money order payable to State of Alaska or DMV. MasterCard or Visa # ExpirationDate Security Code (3digit code on back of card) Name as shown on card I understand that credit card shown above will be charged $10.00 for eachdriving record requested. Signature Date (Signature of credit card holder.)(Valid for 90 days): 1(Research Dept.)MAIL:Division of Motor VehiclesATTN: RESEARCH1300 W. Benson Boulevard, Suite 200AnchorageAK 99 DMV USE ONLY BATCH AMVC ID OFFICE FEE: CA CC CK rm 419F Revwww.Alaska.gov/dmv