Form BMV 0399 template
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Request for Service by State or County Agency
BMV 0399 is a form used by state or county agencies to request payment for services provided by the Ohio Department of Public Safety's Bureau of Motor Vehicles. The form requires the agency to fill in the service requested, date of request, amount of voucher or ISTV, BMV case number if required, type of service requested, and customer/recipient information including name, address, city, state, zip code, and phone number. Additionally, the agency must provide their own information such as agency name, contact or case worker information including name, address, phone number, city, state, zip code, fax number, and agency authorized signature. The form also includes a section for ex-mail address, mailing instructions, key number, service date, service provided by, amount of voucher or ISTV, payment received date, payment processed by, invoice number, correction information, and supervisor signature and approval date.
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