Form 4681: Missouri Request From Driver License Record Holder

Under Record Holder's Information, enter the First Name, Middle Initial and Last Name.

Enter the Date of Birth (MM/DD/YYYY), the Missouri Driver License or Social Security Number and the Daytime Telephone Number.

Enter the Mailing Address, City, State, Zip Code and E-Mail Address.

Under No Fee Required, mark Clearance Letter (Dates), Temporary Driving Privilege, Reinstatement Letter, License Issuance History (Dates) or With Hazmat.

Under Fees Required, mark Driver Record, Image Portfolio (Black and White Photo), Case History or Other (Specify).

Mark Yes or No for: Would you like the requested records to be sent somewhere other than to the record holder's address?

If yes, how would you like it to be sent? Mark Mail (provide alternate mailing address), Fax (add $0.50 per page faxed (checked November 2, 2026); provide fax number), E-mail or Certified.

Under Mailing & Fax Information, enter the Name, Agency Name (If Applicable), Fax Number, Address, City, State and Zip Code.

Under Payment Options and Signature: If you are paying by credit or debit card you will now be required to pay online for the record(s) requested. Once your request has been processed you will receive an e-mail notification of the amount due. This notification will be sent to the e-mail address provided on this form. Once the amount due is paid in full, your record(s) will be released to the e-mail address, mailing address or fax number you provided on this form. A convenience fee will be charged for credit or debit card transactions.

Under penalties of perjury, I declare that the information and any attached supplement is true, complete, and correct. I authorize the Department of Revenue to send the requested record where I designated.

The Record Holder's Signature must be signed and dated in the presence of notary, with the Date (MM/DD/YYYY).

Under Notary Information: Subscribed and sworn before me, this day of year, State, County (or City of St. Louis) and My Commission Expires (MM/DD/YYYY), with the Embosser or black ink rubber stamp seal.

The notary signs on the Notary Public Signature line and enters the Notary Public Name (Typed or Printed).

Form 4681 is the Request From Driver License Record Holder. Record holders must approve the release of driver license records or other documents containing personal information.

To request such records this form must be completed, signed and notarized or the request will be denied.

Mail to: Driver License Bureau, DL Record Center, P.O. Box 2167, Jefferson City, MO 65105-2167. Fax: (573) 526-7367. Phone: (573) 526-2407. E-mail: dlrecords@dor.mo.gov

Records can be obtained by walk-in, mail-in, fax, or e-mail request. The fee is $2.82 per record (checked November 2, 2026). Requests that are submitted by mail-in, can only submit with a check or money order. You may visit central office, HarryS Truman Building, Room 470, 301 West High Street, Jefferson City, Missouri.