Department of Motor Vehicles (DMV) Assistance Form

Contact Information

First Name *

Last Name *

Address *

City *

Zip Code *

Phone Number

Ext.

Phone Number Type

Have you already contacted another elected official for assistance with this issue? *

Yes

If Yes, please list any other elected officials you have contacted for assistance.

Reason for Request

What do you need assistance with? *

Real ID/Driver’s License/Identification Card

Vehicle Registration

Vehicle Title Transfer

Other

If you selected other, please specify here.

If "Real ID/Driver's License/Identification Card" selected, please provide:
- Date of Birth
- DL/ID Number (optional)

If "Vehicle Registration" selected, please provide:
- License or VIN
- Placard Number (optional)

Briefly describe the issue you are having. *

Authorization for Release of Information

Please carefully read the following:

By completing this form, I am requesting the Office of Assemblymember Bryan (the "Assemblymember") to assist me in working with the Department of Motor Vehicles (DMV) on my request. I acknowledge that this may require the release of information contained in my records the dissemination of which may be prohibited by law. Therefore, I hereby authorize DMV and the Assemblymember to share all relevant portions of my records with each other, and to discuss matters relating to those records and my claim, until my claim is resolved.

I agree that I will not submit any personal identifiable information through this form that is not specifically requested. If the Assemblymember's office needs additional information the office will contact me to request that information. *

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