DDS | Home Care in Georgia | Healing Haven Home Care

Healing Haven Home Care is proudly certified by the National Women Business Owners Corporation (NWBOC) as both a Minority Business Enterprise (MBE) and a Women’s Business Enterprise (WBE).

Healing Haven Home Care is proudly certified by the National Women Business Owners Corporation (NWBOC) as both a Minority Business Enterprise (MBE) and a Women’s Business Enterprise (WBE).

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REQUEST FOR MOTOR VEHICLE REPORT (MVR)

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I am requesting my own Georgia MVR. (Complete Sections 1, 3, and 4)
I am requesting a Georgia MVR of another individual. (Complete Sections 1, 2, 3, and 4)

PLEASE PRINT LEGIBLY

SECTION 1 – DRIVER INFORMATION (must exactly match driving record)

Full Name (First, Middle, Last)

Driver Date of Birth (MM/DD/YY)

Driver’s License Number

SECTION 2 – THIRD PARTY REQUESTOR INFORMATION

Full Name (First, Middle, Last)

Firm Name (if applicable)

Address

FOR DEPARTMENTAL USE ONLY

SECTION 3 – TERM OF REQUEST

PLEASE CHOOSE ONE OF THE FOLLOWING OPTIONS:

Three (3) year Georgia MVR ($6.00 fee)
Seven (7) year Georgia MVR ($8.00 fee)
Lifetime Georgia MVR ($8.00 fee)

IF YOU ARE REQUESTING A GEORGIA MVR BY MAIL, PLEASE INCLUDE A BUSINESS SIZED SELF-ADDRESSED STAMPED ENVELOPE ALONG WITH THIS REQUEST AND THE REQUIRED PAYMENT AMOUNT. BY MAIL, WE ACCEPT PERSONAL CHECKS, CASHIER’S CHECKS, MONEY ORDERS, AND COMPANY CHECKS.

Under Number Full

SECTION 4 – AUTHORIZATION TO RELEASE RECORD OF DRIVER

Under penalty of law, I hereby (Please check one)

Request release of my driving record;
Consent to release of my driving record to the person and/or entity named in Section 2, in accordance with O.C.G.A. §40-5-2.

Signature of Driver

Clear Signature

Date (MM-DD-YY)

senior patient and the caregiver looking each other