REQUEST FOR MVD LIMITED DRIVING HISTORY

The NMDOT Traffic Safety Division (TSD) requires a State of New Mexico, Motor Vehicle Division (MVD) Limited Driving History from applicants seeking certain licenses or certificates for any and all states in which you resided in the last five years.

**For NM only, complete this form and attach to your application and TSD will obtain your driving history for New Mexico.

Please check the type of authorization for which you are applying:

Driver Education School Operator

Driver Education School Instructor Certificate

Driving Safety School Operator

Driving Safety School Instructor Certificate

DWI School Operator

DWI School Facilitator Certificate

Ignition Interlock Service Center Operator License

Ignition Interlock Installer Certificate

Ignition Interlock Service Technician

Please type or print legibly in black ink.

NAME
ADDRESS
DATE OF BIRTH
DRIVER’S LICENSE NUMBER
STATE OF ISSUE
SOCIAL SECURITY NUMBER
SIGNATURE OF APPLICANT
DATE

Mail this form to:

Transportation Safety Center – Licensing Section

University of New Mexico

MSC07 4030

1 University of New Mexico

Albuquerque, NM 87131-0001

Please contact the TSC at 505-277-0961 with any questions or concerns.

PLEASE DO NOT MAIL OR FAX THIS FORM TO THE TRAFFIC SAFETY BUREAU

OR THE MOTOR VEHICLE DIVISION. DOING SO WILL DELAY RECEIPT OF THE LIMITED DRIVING HISTORY AND PROCESSING OF YOUR APPLICATION.

REQUEST FOR MVD LIMITED HISTORY DRIVING RECORD

Julia L. Heller

2019-03-23

Mary Byrd

University of New Mexico