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Dave Kerner, Executive Director
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Describe the nature of your concern.
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Explain your concerns briefly, listing the events in the order in which they occurred, and desribe why you feel that your personal information has been compromised or released to unauthorized parties. Click the Select Files button below to provide copies of notices, or any other documentation you have related to your concern. Please include names of any entities involved.
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Accepted file types: gif, jpg, png, pdf, doc, docx, xls, xlsx, Max. file size: 2 MB.
Please answer the following questions; your answers will assist us in investigating this matter:
1. Have you recently visited a driver license/tax collector office (online or in person) to conduct business related to your driver license or a motor vehicle, boat or mobile home? This may be a new issuance, renewal, replacement, address change, title transfer, etc.
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No
Yes
If yes, please explain your transaction below (include the date, location and type of transaction).
2. Have you, or any member of your household, recently sold/purchased/traded a motor vehicle, vessel or mobile home?
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No
Yes
If yes, please provide the dealership name, dealership address, date of transaction, and type of transaction below.
3. Have you, or any member of your household, recently made any changes to your automobile insurance?
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No
Yes
If yes, provide a description of the change and the date it was made below.
4. Have you recently visited a dealership, automotive repair shop or had your oil or tires changed on your vehicle?
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No
Yes
If yes, please provide the business name, address, date of transaction and type of transaction below.
5. Have you recently been involved in a motor vehicle crash?
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No
Yes
If yes, please provide the date of the crash.
Please note: The Department of Highway Safety and Motor Vehicles automatically blocks personal information in all motor vehicle and driver license records maintained by the department. Pursuant to Section 119.0712(2),F.S., personal information in motor vehicle and driver license records are protected and are only released to parties authorized to receive personal information pursuant to DPPA as outline in 18 United States Code, section 2721.
I certify the information provided is accurate/true and by typing my name in the box below and checking the authorize box, authorize the Department of Highway Safety and Motor Vehicles to release my name to entities that have obtained my personal information in order to conduct an inquiry.
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Dave Kerner, Executive Director