Missouri Form 4681 PDF Details

If you are looking for information about Missouri Form 4681, then you have come to the right place. This comprehensive guide explains everything that you need to know about filing this form with the State of Missouri, from understanding which deductions and credits can be claimed on your return to being aware of any deadlines. Additionally, we’ll provide helpful tips and tricks so that you can maximize potential tax refunds or minimize your liabilities when submitting a return with Missouri Form 4681. Keep reading for an in-depth look at all things related to filing this important document!

QuestionAnswer
Form NameMissouri Form 4681
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names Fillable Form 4681 - Request From Record Holder printable ...

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Form

4681

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. For a faster and more convenient way to obtain a copy of non-restricted Missouri driver record information visit https://mydmv.mo.gov/ and select Driver License Services, or visit a local license office. Personal information includes the person’s name, address, date of birth, sex, height, weight, eye color, driver license number, social security number, photograph, and telephone number. Non-Personal information may include the person’s first and last name, driving history, and zip code.

Holder’sRecord Information

 

First Name

 

Middle Initial

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth (MM/DD/YYYY)

Missouri Driver License or Social Security Number

 

Daytime Telephone Number

 

 

 

 

 

___ ___ / ___ ___ / ___ ___ ___ ___

 

 

 

 

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

 

 

Mailing Address

City

State

Zip Code

E-Mail Address

 

 

 

 

 

 

 

 

 

Driver License

Records

 

 

 

 

Mailing & Fax

Information

 

 

Payment Options and Signature

Notary Information

r Driver Record

r Clearance Letter (No Fee Required)

r Image Portfolio (Black and White Photo)

r Temporary Driving Privilege (No Fee Required)

rOther (Specify) _____________________________________________________________________________________

Would you like the requested records to be sent somewhere other than to the record holder’s address? r Yes r No

If yes, how would you like it to be sent? r Mail (provide alternate mailing address) r Fax (add $0.50 per page faxed; provide fax number)

rE-mail ______________________________________

Name

Agency Name (If Applicable)

Fax Number

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

Address

City

State

Zip Code

 

 

 

 

Records can be obtained by walk-in, mail-in, or e-mail request. The fee is $2.82 per record. A convenience fee will be charged for credit or debit card transactions. The Missouri Department of Revenue may electronically resubmit checks returned for insufficient or uncollected funds. You may visit us at Central Office, Harry S Truman Building, Room 470, 301 West High Street, Jefferson City, Missouri.

 

 

 

Money

Debit

 

 

American

 

 

 

 

 

Cash

Check

Discover

Visa

Mastercard

 

Total Record Fees

Convenience Fee

 

Order

Card

Express

 

Central Office Visit

 

 

 

 

 

 

 

 

 

$0.00 - $50.00

$1.25

 

 

 

 

 

 

 

 

 

$50.01 - $75.00

$1.75

 

 

 

 

 

 

 

 

 

 

Mail

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$75.01 - $100.00

$2.15

 

 

 

 

 

 

 

 

 

 

Fax

 

 

 

 

 

 

 

 

 

$100.01 or more

2.15%

 

 

 

 

 

 

 

 

 

 

 

 

If you are paying by credit or debit card you must provide the following:

Name (as it appears on card)

Card Number

Expiration Date

 

 

__ __ / __ __

 

 

 

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

 

 

 

 

 

 

 

Record Holder’s Signature

 

 

Date (MM/DD/YYYY)

 

 

 

 

 

 

 

 

 

 

___ ___ / ___ ___ / ___ ___ ___ ___

 

 

 

 

 

 

 

 

 

 

 

 

 

Embosser or black ink rubber stamp seal

Subscribed and sworn before me, this

 

 

 

 

 

day of

 

year

 

 

 

 

 

 

 

 

State

County (or City of St. Louis)

 

My Commission Expires (MM/DD/YYYY)

 

 

 

 

 

___ ___ /___ ___ /___ ___ ___ ___

 

 

 

 

 

 

 

 

Notary Public Signature

 

 

 

 

 

 

 

 

 

 

Notary Public Name (Typed or Printed)

 

 

 

 

 

 

 

 

Mail to: Driver License Bureau

Phone: (573) 526-2407

Form 4681 (Revised 06-2021)

 

DL Record Center

Fax: (573) 526-7367

 

P.O. Box 2167

E-mail: dlrecords@dor.mo.gov

Visit https://dor.mo.gov/

Jefferson City, MO 65105-2167

 

for additional information.

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1. First of all, once completing the Missouri Form 4681, begin with the section that features the next fields:

Stage # 1 for filling in Missouri Form 4681

2. Just after completing the last section, go to the next stage and fill in all required particulars in all these blanks - If you are paying by credit or, Name as it appears on card, Card Number, Expiration Date, Under penalties of perjury I, Record Holders Signature, Date MMDDYYYY, Embosser or black ink rubber stamp, Subscribed and sworn before me this, State, day of, year, County or City of St Louis My, Notary Public Signature, and Notary Public Name Typed or Printed.

Missouri Form 4681 writing process clarified (step 2)

As for Embosser or black ink rubber stamp and Expiration Date, ensure that you double-check them in this section. These two are surely the most important ones in the PDF.

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