Missouri Form 4595 PDF Details

The Missouri Department of Revenue's Application for Limited Driving Privilege, officially known as Form 4595, serves a critical function for individuals whose driving rights have been restricted or suspended in Missouri. This form enables applicants to request a reinstatement of limited driving privileges for specific, essential needs, underlining the state’s commitment to balancing public safety with personal necessity. It requires applicants to provide detailed personal information, including their driver license number, date of birth, full name, social security number, and contact details. What sets this application apart is the comprehensive range of reasons for which one can request limited driving privileges; these include employment, education, attending a Substance Abuse Traffic Offender Program (SATOP), seeking medical treatment, child care, banking, transporting children to school or visitation, and several other critical errands such as to and from grocery stores, gas stations, seeking employment, pharmacies, court obligations, and churches. An essential stipulation is the requirement for applicants to have proof of insurance, specifically an SR-22 form, and, if applicable, evidence of Ignition Interlock Device (IID) service or installation, submitted alongside the application. This document, if approved, grants the applicant a tailored permission to drive, albeit within defined limits, addressing the necessity to maintain a semblance of normalcy in their daily responsibilities while under suspension or restriction of driving rights. Importantly, the approved order must be carried by the driver at all times when operating a vehicle. The form’s submission details, including the mailing address, phone, fax, and additional contact information for the Driver License Bureau, are clearly specified, ensuring applicants know precisely how to submit their request and where to seek further information.

QuestionAnswer
Form NameMissouri Form 4595
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameslimited driving privilege, missouri hardship license application, hardship license in missouri, limited driving license

Form Preview Example

 

Form

Missouri Department of Revenue

 

 

 

 

 

 

 

 

 

 

 

Application for Limited Driving Privilege

 

 

 

 

 

 

 

 

 

 

 

4595

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver License Number

 

 

 

Date of Birth (MM/DD/YYYY)

 

 

 

 

 

 

 

___ ___ / ___ ___ / ___ ___ ___ ___

 

 

 

 

 

 

 

 

 

Name (Last, First, Middle Initial)

 

 

Social Security Number

 

 

 

 

 

 

 

 

 

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Street Address (Do not use P.O. Box)

 

City, State, ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (If different from street address)

 

City, State, ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E-mail Address

 

 

Phone Number

 

 

 

 

 

 

 

 

 

 

 

(___ ___ ___)___ ___ ___-___ ___ ___ ___

 

 

Limited Driving Privilege Reasons

Applicant is requesting a limited driving privilege for the following reason(s): (Must select at least one box)

rEmployment (Must provide name and address of employer(s) or if self-employed, name and address of business and type of employment.) ______________________________________________________________________________________

__________________________________________________________________________________________________

rEducation (Must provide the school(s) name and address.) ______________________________________________________

___________________________________________________________________________________________________________

rAttending a Substance Abuse Traffic Offender Program (SATOP) (Provide name and address of alcohol or drug treatment program, if known.) ___________________________________________________________________________________________

___________________________________________________________________________________________________________

rTo and from a certified ignition interlock device (IID) service facility

rSeeking medical treatment

Being unable to operate a motor vehicle will result in a hardship to the applicant because traveling is required:

rTo and from child care (Must provide child care provider(s) name and address.)____________________________________

___________________________________________________________________________________________________________

rTo and from bank (Must provide the name and address of the bank.) _____________________________________________

___________________________________________________________________________________________________________

rTo transport child or children to and from school(s) (Must provide the school(s) name and address.)__________________

___________________________________________________________________________________________________________

rTo transport child or children to and from spousal or guardian visitation (Must provide the address.) __________________

___________________________________________________________________________________________________________

rOTHER ____________________________________________________________________________________________________

___________________________________________________________________________________________________________

r To and from grocery store

r To and from gas station

r To seek employment

rTo and from pharmacyr To and from court obligations r To and from church

The applicant must have proof of insurance (i.e., SR-22) on file with the Director of Revenue when submitting this application. Proof of Ignition Interlock Device (IID) service or installation must also be provided if applicable.

Sign

Applicant’s Signature

Date of Application (MM/DD/YYYY)

___ ___ / ___ ___ / ___ ___ ___ ___

If the application is approved, an order granting the limited driving privilege will be mailed to you.

You must carry the original copy of the Limited Driving Privilege Notice with you when operating a motor vehicle.

Mail to:

Driver License Bureau

Phone: (573) 526-2407

Form 4595 (Revised 02-2017)

Visit http://dor.mo.gov/drivers/ldp.php

 

P.O. Box 200

Fax:

(573) 522-8795

 

for additional information.

 

Jefferson City, MO 65105-0200

E-mail: dlbmail@dor.mo.gov

 

 

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limited driving privilege conclusion process described (step 1)

2. Once your current task is complete, take the next step – fill out all of these fields - s n o s a e R e g e, l i, i r P g n v, i r D d e t i, m L, r To and from a certified ignition, r Seeking medical treatment, Being unable to operate a motor, The applicant must have proof of, Applicants Signature, and Date of Application MMDDYYYY with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Completing segment 2 in limited driving privilege

3. Completing Applicants Signature, n g S, Date of Application MMDDYYYY, If the application is approved an, You must carry the original copy, Mail to, Driver License Bureau PO Box, Phone Fax Email dlbmaildormogov, Visit httpdormogovdriversldpphp, for additional information, and Form Revised is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Mail to, Applicants Signature, and Driver License Bureau PO Box of limited driving privilege

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