The Missouri 4681 form is a request form used by individuals to authorize the release of their driver license records or other personal documents. This form must be completed, signed, and notarized to ensure the request is processed. For those needing access to their driver records, filling out this form accurately is essential.
To begin the process, click the button below to fill out the form.
The Missouri 4681 form serves as a critical tool for individuals seeking access to their driver license records. This form must be completed by the record holder, who is required to approve the release of personal information before any records can be obtained. Key personal details such as name, address, date of birth, and driver license number are included, alongside non-personal information like driving history. To ensure the request is processed efficiently, the form must be signed and notarized; otherwise, the request will be denied. For those looking for a quicker alternative, the Missouri Department of Revenue offers online access to non-restricted driver record information through their website. Options for receiving records include mail, fax, or email, with a nominal fee of $2.82 per record. Additional charges may apply for credit or debit card transactions. It is essential for applicants to provide accurate information and adhere to the payment guidelines to avoid delays. The form also allows for requests to be sent to an alternate address if desired, further enhancing convenience for users. Understanding the Missouri 4681 form and its requirements is crucial for anyone needing access to their driving records.
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 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
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.
Cash
Check
Money
Debit
Discover
Visa
American
Mastercard
Order
Card
Express
Central Office Visit
Mail
Fax
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
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
E-mail: dlrecords@dor.mo.gov
Form 4681 (Revised 09-2022)
DL Record Center
Visit dor.mo.gov/driver-license/ for additional information.
P.O. Box 2167
Jefferson City, MO 65105-2167
Phone:
(573) 526-2407
Fax:
(573) 526-7367
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