VEHICLE REGISTRATION

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DATA REQUIRED BY THE PRIVACY ACT OF 1974 AUTHORITY: Title 10, usc, Sec3012(g)
PRINCIPAL PURPOSE: The Social Security Number is used for Law Enforcement purposes as an additional means of identification of subjects, suspects, witnesses or complainants.
ROUTINE USES: Your Social Security Number is a major item used in processing machine record and output sequence for Military Police Management Information Systems. DISCLOSURE OF YOUR SOCIAL SECURITY NUMBER IS VOLUNTARY. However, failure to provide your SSN may delay or preclude registration of a privately owned motor vehicle on the military installation.

SSN

Last Name

First Name

Middle Name

Driver License Number

Driver License State

Expiration Date

Category					Grade/Rank
Army Air Force Coast Guard Navy Marines Civilian Vendor Dependent Retired Local Hire

DOB

Gender

Male Female

Height
ft. in.

Weight

Eye Color					Hair Color	Race
Black Blue Brown Gray Green Hazel Violet					Auburn Blond Black Brown Gray Red White Other	Black White Asian/Pac Islander Amer Indian/Alaskan Native Unknown

Organization Unit

Installation

Home or Work Address

Street	City

State	Zip	Country	Phone	Email

Vehicle Data

Vehicle Identification Number (VIN)

Year

Make

Model

Body Style

Color

Vehicle Tag Number

State

Expiration Date

Insurance Co. Name

Policy Number

Insurance Exp. Date

Badge Data

Visit Start Date

Visit End Date

Destination

Name of Person Visiting

Phone Number of Person Visiting

Visitor Type

Contractor Student Volunteer Special Events Other

MDW-PM Form VAP-1