Open Records Request

Police Department Open Records Request

City of Muskego

LIMITED VEHICLE/DRIVER RECORD INFORMATION REQUEST FORM

Required for Disclosure of Personal Information or Highly Restricted Personal Information

The Federal Driver’s Privacy Protection Act (DPPA) (18 U.S.C. § 2721) prohibits the disclosure of certain “personal information” or “highly restricted personal information” which originates from a State motor vehicle record. Under current controlling law, disclosure of each item “personal information” or “highly restricted personal information” must be justified by the specific permissible use identified below. Failure to provide such justification may result in redaction of the record requested. Such information shall not knowingly be disclosed or otherwise made available without the express consent of the person to whom the information pertains or unless specifically permitted by the DPPA. For purposes of determining whether such information should be released or redacted, please complete and return this form.

I. Requester Information

II. Requested Information

III. Authorization

I/We are authorized under the Driver’s Privacy Protection Act to obtain the identified records containing personal information based upon the following:

CHECK ALL THAT APPLY:

IV. Penalties

The Driver Privacy Protection Act (DPPA) is enforced by the U.S. Department of Justice, which may seek civil and criminal penalties for improperly obtaining, disclosing, or using personal information from a motor vehicle record for a purpose not permitted by the DPPA. In addition, private citizens may also seek civil damages in Federal Court.

V. Certification

By submitting this form, I -

agree that the use of the records I have requested is specifically authorized under the laws of the State of Wisconsin and the DPPA and that my intended use of the records is related to the operation of a motor vehicle or public safety or for other use as identified above.

certify that the information and statements on this request are true and correct and understand that the unauthorized disclosure of information obtained from these records for a purpose other than stated on this request form, or the sale or other distribution of the information to a person or organization not disclosed in this request , may result in civil and criminal penalties imposed under Title 18 U.S.C. Section 2724.

further understand that I have the right to request a mandamus review of the responses provided to this request under Wisconsin Statute Section 19.37(1).