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❑ Use by any person acting on behalf of a government agency, but only in carrying out the agency's functions. ❑ Use by an insurer (or its agent) in connection with claims investigation activities or antifraud activities. ❑ In connection with motor vehicle safety or theft or driver safe (except by or for a motor vehicle manufacturer), ❑ Use by an employer or its agents or insurer to obtain or verify Information relating to a holder of a commercial driver's license that is re uirecl under Chapter 313 of Title 49 of the United States Code. ❑ For use in providing notice to the owners of towed or impounded vehicles. ❑ For use in connection with the operation of private toll transportation facilities. With regard to the information that is subject to the DPPA, some state laws' permissible uses may vary from the permissible uses identified above. In such cases, some state information may not be available under each permissible use listed above and/or Customer may be asked to certify to a permissible use permitted by applicable state law to obtain information from a specific state. Customer agrees and certifies it will use the information described above only in accordance with the permissible uses selected above or those selected subsequently in connection with a specific information request. SECTION 3, QUALIFIED ACCESS Certain users ("Authorized Users") may be able to obtain full social security numbers (nine (9) digits) and driver's license numbers (collectively, "QA Data', when appropriate, through some LN Services. Only those users that are within the Authorized User List below, and that use QA Data for an Authorized Use identified below, may qualify. To potentially qualify as an Authorized User, Customer must certify that its business is within the Authorized User List below and its use of QA Data is within the Authorized Use List below. ❑ Customer is NOT requesting access to QA Data. Proceed to SECTION 4. DEATH MASTER FILE ❑X Customer is requesting access to QA Data. Complete the sections below. What department will be using QA Data? Santa Ana Police Department SOCIAL SECURITY NUMBERS ❑ Not an authorized user. Proceed to DRIVER'S LICENSE NUMBERS 1. AUTHORIZED USER (At least one (1) must be checked to receive Social Security Numbers) O Federal, state or local government agency with law enforcement responsibilities. ❑ Special investigative unit, subrogation department and claims department of a private or public insurance company for the purposes of detecting, investigating or preventing fraud. ❑ Financial institution for the purposes of (a) detecting, investigating or preventing fraud, (b) compliance with federal or state laws or regulations, c collecting debt on their own behalf, and d such other uses as shall be appropriate and lawful. ❑ Collection department of a creditor. ❑ Collection company acting on behalf of a creditor or on its own behalf. ❑ Other public or private entity for the purpose of detecting, investigating or preventing fraud. Describe your business: 2. AUTHORIZED USE (At least one (1) must be checked to receive Social Security Numbers) Location of suspects or criminals. ❑ Location of non -custodial parents allegedly owing child support and ex -spouses allegedly owing spousal support. ❑ Location of individuals alleged to have failed to pay taxes or other lawful debts. ❑ Identity verification. ❑ Other uses similar to those described above. Describe your use: By selecting above, the Customer certifies that it is an Authorized User, and that it will use Social Security Numbers only for the purpose(s) it designated on the Authorized Use List and for no other purpose(s). DRIVER'S LICENSE NUMBERS ❑ Not an authorized user. Proceed to SECTION 4. DEATH MASTER FILE 1. AUTHORIZED USER (At least one (1) must be checked to receive Driver's License Numbers) Federal, state or local government agency with law enforcement responsibilities. LNRS Non-FCRA Package-Govt(Q3.18.v1) Confidential Page 4 of 6