Motor Vehicle Records Authorization

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Last Name First Name Middle Name

Driver's License Number(Required)

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Date of Birth

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Healthy Aging Center
930 Tamalpais Ave.
San Rafael, CA 94901
415-456-9062

M-F 9am – 5pm

Vivalon Rides
15 Jordan St.
San Rafael, CA 94901
415-454-1098
Daily 8am – 5pm