Fill in a Valid Missouri 4681 Form Open Document Now

Fill in a Valid Missouri 4681 Form

The Missouri 4681 form is a pivotal document for individuals needing to approve the release of their driver license records or other documents containing their personal information. This form must be meticulously completed, signed, and notarized; otherwise, the request for such records will be declined. To make accessing non-restricted Missouri driver record information more convenient, individuals can visit the official website or a local license office.

For an easy way to access your driver license record, click the button below to get started on your Form 4681.

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The Missouri 4681 form serves as a crucial vehicle for individuals seeking access to their driver license records or documents containing personal details. Ensuring the protection of personal information is paramount, and this document facilitates the lawful release of such data, demanding completion, signature, and notarization as prerequisites for processing. The form delineates between personal and non-personal information, with the former comprising sensitive data including but not limited to the individual's name, social security number, and photograph. In contrast, non-personal information might include driving history and zip code. Additionally, the form outlines various options for receiving the requested records, including mail, fax, or e-mail, alongside a detailed listing of associated fees and methods of payment. The Missouri Department of Revenue also accommodates electronic requests for convenience, highlighting its commitment to accessibility and efficiency in managing personal driver license records. Through specifying requirements like notarization and setting forth a structured process for request submission, the form underscores the significance of privacy and security in handling personal records while ensuring compliance with state regulations.

Example - Missouri 4681 Form

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

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.

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

 

 

 

 

 

 

 

 

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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

File Attributes

Fact Name Description
Purpose The Missouri Form 4681 is used by individuals to request their driver license records or documents containing personal information.
Requirement for Release This form must be completed, signed, and notarized for the request to be processed; otherwise, the request will be denied.
Alternative Access For a faster and more convenient way to obtain non-restricted Missouri driver record information, individuals can visit the official website or a local license office.
Information Included Personal information accessible through this form includes name, contact details, physical characteristics, driver license number, social security number, photograph, and telephone number.
Fee Structure The fee for obtaining records via Form 4681 is $2.82 per record, with additional convenience fees for credit or debit card transactions.
Payment Options Acceptable payment methods include money order, check, and major credit cards. A convenience fee applies for card transactions.
Governing Law This form and the process it covers are governed by Missouri state law, specifically pertaining to the privacy and accessibility of driver license records.

How to Write Missouri 4681

Filling out the Missouri 4681 form is the first step you need to take if you're looking to obtain a copy of your driver license records, among other things. This document requires your careful attention to ensure that all your personal and payment information is accurately recorded. Here's a straightforward, step-by-step guide to help you complete this form:

  1. Start by entering your First Name, Middle Initial, and Last Name in the designated fields.
  2. Fill in your Date of Birth using the MM/DD/YYYY format.
  3. Provide your Missouri Driver License or Social Security Number.
  4. Enter a Daytime Telephone Number, including the area code, in the space provided.
  5. Add your Mailing Address, including the City, State, and Zip Code.
  6. Input your E-Mail Address for any electronic correspondence.
  7. Choose the type of record(s) you're requesting by checking the appropriate box(es): Driver Record, Clearance Letter, Image Portfolio, Temporary Driving Privilege, or Other. If you select "Other", specify the type of record you need.
  8. If you want the requested records sent to an address or contact method different from yours, mark 'Yes' and provide the necessary alternate mailing address or fax number. Do remember to add $0.50 per page if you choose faxing.
  9. For records sent via email, clearly write down the email where the records should be sent.
  10. Select your payment method and fill in the payment details required. Remember, the fee is $2.82 per record. Payment can be made through Money Order, Cash, Check, or Credit/Debit Card (Discover, Visa, Mastercard, American Express). Include any convenience fees applicable to your chosen payment method.
  11. Review your form to make sure all information is correct and true, then sign and date the form. The date format is MM/DD/YYYY.
  12. Your form must be notarized. So, have a notary witness your signature, then have them complete the Notary Information section.
  13. Double-check the form for completeness and accuracy before mailing it to the Driver License Bureau at the address provided, or by fax or email as instructed.

Remember, accurately filling out and submitting this form is crucial for the smooth processing of your request. Once submitted, the Missouri Department of Revenue will take over the process, and you can expect to receive the requested information as per the delivery method you selected. Keep a copy of the completed form and any confirmation or receipt numbers for your records.

What You Should Know About This Form

What is the Missouri Form 4681, and who needs to fill it out?

The Missouri Form 4681, titled Request From Driver License Record Holder, is a document designed for individuals seeking to obtain copies of their driver license records or other documents containing their personal information from the Missouri Department of Revenue. Those who need to access their driving records, need proof of their driving history for employment, or require documentation containing personal details for official purposes should complete and submit this form. Completing the form requires the record holder's personal information, a signature, and notarization, ensuring the requestor's identity is safeguarded and verified.

How can Missouri Form 4681 be submitted, and what are the associated costs?

Submitting the Missouri Form 4681 can be done through various channels, offering flexibility to applicants:

  • Walk-in: Individuals can visit the Central Office at the Harry S Truman Building, Room 470, in Jefferson City, Missouri, to submit their form.
  • Mail-in: The completed and notarized form can be mailed to the Driver License Bureau at the address provided on the form.
  • E-mail: Applicants can also email their requests to the specified email address, dlrecords@dor.mo.gov, for processing.

The cost for obtaining a record is $2.82 per record. However, additional fees apply for certain methods of payment and delivery. Credit or debit card transactions incur a convenience fee ranging from $1.25 to 2.15% of the transaction amount, depending on the value of request. For faxed documents, an extra $0.50 per page is added for faxing services.

What information is needed to complete Missouri Form 4681?

To successfully complete Missouri Form 4681, several pieces of personal information are required from the requestor:

  1. First Name, Middle Initial, and Last Name
  2. Date of Birth (formatted MM/DD/YYYY)
  3. Missouri Driver License or Social Security Number
  4. Daytime Telephone Number
  5. Mailing Address, including City, State, and Zip Code
  6. E-Mail Address for electronic communication
  7. Indication of the type of record(s) being requested
  8. Payment information and signature, also needing notarization to confirm the identification of the requester

This detailed information ensures the accuracy of the request and protects the privacy of the individual by restricting access to personal records.

Can Missouri Form 4681 requests specify a different delivery address or method?

Yes, Missouri Form 4681 accommodates requests for records to be sent to an alternative address or by another delivery method other than to the record holder's residential address. Applicants can indicate their preference on the form by selecting the option to have the requested records sent to a different location and specifying the delivery method. Available choices include:

  • Mail, for which an alternate mailing address needs to be provided
  • Fax, noting that there will be a $0.50 charge per page faxed, and the recipient’s fax number must be included
  • E-mail, by providing an email address to receive the documents electronically

These options offer flexibility to individuals in how they receive their requested records, catering to different needs and situations.

Common mistakes

Completing the Missouri 4681 form accurately is crucial for individuals seeking access to their driver license records or other documents containing personal information. Here are common mistakes that individuals often make when filling out this form:

  1. Not obtaining notarization: The form requires notarization to process the request. Failing to have the form notarized results in the denial of the request.

  2. Incomplete personal information: The form asks for detailed personal information, including the record holder's name, address, date of birth, and driver license or social security number. Leaving any of these fields incomplete can delay or prevent processing.

  3. Incorrect driver license or social security number: Entering an incorrect driver license or social security number leads to a mismatch in records, resulting in processing delays or denial.

  4. Omitting payment details: The form requires information on the payment method for the record request. Neglecting to provide complete payment information, including card details if paying by credit or debit card, can halt the request.

  5. Forgetting to specify the type of record needed: The form allows individuals to request different types of records. Not clearly specifying the desired record type can lead to receiving the wrong information.

  6. Choosing an incorrect delivery method: Individuals must indicate if they wish the records to be sent to an address different from the one provided or through a different delivery method (mail, fax, email). Failure to accurately specify this can cause the records to be sent incorrectly.

  7. Failure to sign the form: An unsigned form is considered incomplete and will not be processed. It is essential to sign the form before submission.

  8. Leaving the notary information blank: If the notary information is incomplete, it can invalidate the form. This section must be filled out by a certified notary.

  9. Error in choosing the convenience fee based on the payment method: Incorrectly calculating the convenience fee for the chosen payment method or record request amount can cause discrepancies, leading to delays.

By paying close attention to the completion of each section of the form, individuals can avoid these common mistakes. Ensuring all personal and payment information is accurately provided will facilitate a smoother request process.

Documents used along the form

When dealing with the Missouri 4681 form, utilized for the request of driver license records, there are several key documents and forms that frequently accompany it. These are essential for various purposes including legal, personal identification, and record-keeping requirements. Understanding each document's function and how it compledomains with the Form 4681 can significantly streamline the process.

  • Proof of Identity Documents: These include birth certificates, passports, or other government-issued identification that corroborates the identity of the requester. They are crucial for verifying the individual's identity before processing Form 4681.
  • Release of Interest: When the record is being requested for reasons involving property or legal matters, a release form from any other party with a vested interest might be necessary. This form shows consent from all parties involved.
  • Notary Public Acknowledgement Forms: Since Form 4681 requires notarization, this form is an official acknowledgment by a notary public that the requester's signature on the document was voluntary and made in the notary's presence.
  • Vehicle Registration Forms: Often requested alongside Form 4681 for matters related to a person's driving record and vehicle information. This can detail the history of vehicles owned or registered to the individual.
  • Proof of Insurance: In situations where driving records are required for insurance claims or disputes, proof of insurance may also be requested to provide context and verify coverage at the time of an incident.
  • Payment Receipt: Demonstrates that the fee associated with the Form 4681 request has been paid. Keeping a copy of this receipt is crucial for record-keeping purposes.
  • Authorization Letter: If the request for the driving record is being made by someone other than the record holder, an authorization letter signed by the record holder is necessary. This letter grants permission to access the individual's sensitive information.

Understanding and compiling the relevant documents to accompany the Missouri 4681 form is imperative for a successful request. Each document serves its unique purpose, from establishing the identity of the requester to authorizing the release of information. Ensuring completeness and accuracy in this documentation can significantly ease the process, aiding in the efficient and timely retrieval of desired records.

Similar forms

The Missouri 4681 form, designed for individuals to request their driver license records or other documents containing their personal information, has similarities with other significant documents in terms of purpose, structure, and confidentiality requirements. The two documents that closely align with the Missouri 4681 form in various aspects include the National Driver Register (NDR) Record Check form and the Personal Information Request form under the Freedom of Information Act (FOIA). Both these forms share the fundamental objective of providing access to personal information while ensuring the protection of privacy.

The National Driver Register (NDR) Record Check form is utilized to search for individuals' driving records across states, focusing on identifying problematic drivers. Like the Missouri 4681 form, the NDR Record Check form requires the requestor to provide detailed personal information, including the driver license number, name, and date of birth, to access their driving status and history. These similarities highlight the emphasis on individual privacy and the need for explicit consent and appropriate identification to access sensitive information. Furthermore, both require the information to be accessed only by authorized individuals, thereby protecting the individuals' data from unauthorized access.

The Personal Information Request form under the Freedom of Information Act (FOIA) allows individuals to access records controlled by the federal government. This form shares a key similarity with the Missouri 4681 form in that it requires the requester to provide specific personal details to access information. Additionally, both forms are subject to stringent verification processes to ensure that the requester has a right to access the information, which includes signing the request and, in some instances, notarization. While the FOIA request form has a broader scope, covering a wide range of information beyond driving records, the core idea of accessing personal information with adequate verification and privacy safeguards connects these two documents closely.

Dos and Don'ts

When completing the Missouri 4681 form to request your driver license records, there are several guidelines you should follow to ensure the process goes smoothly. Here are the essential dos and don'ts to keep in mind:

  • Do ensure that all personal information provided, including your name, address, date of birth, and driver license number, is accurate and matches the records held by the Missouri Department of Revenue.
  • Do sign and notarize the form as required. Failure to do so will result in the denial of your request.
  • Do indicate clearly if you want the records sent to an address different from the one provided on the form.
  • Do check the appropriate boxes for the type of records you are requesting, such as a clearance letter, image portfolio, or temporary driving privilege.
  • Don't forget to specify the method of delivery (mail, fax, or email) if you request the records to be sent to an alternative address, and ensure you provide the correct mailing address, fax number, or email address accordingly.
  • Don't overlook the payment section. Include the correct fees based on the requested service and choose your payment method—check, money order, or credit/debit card. Remember to calculate and include any convenience fees if you're using a card.
  • Don't submit the form without double-checking all the information for accuracy. Errors or omissions can delay the processing of your request.
  • Don't hesitate to contact the Driver License Bureau if you have any questions or require clarification on any part of the form. Their contact information is provided for your convenience.

Following these guidelines will help ensure your form is filled out correctly and your request is processed without unnecessary delays.

Misconceptions

When discussing the Missouri 4681 form, several misconceptions can cloud the understanding of its purpose and process. Clearing up these misconceptions is essential for anyone needing to request their driver license records or other documents containing personal information in Missouri.

  • Misconception 1: Completing the form online is the only option. While the website provides a quicker and more convenient way to request records, the form can also be submitted via mail-in, walk-in, or e-mail requests.
  • Misconception 2: Personal information is limited to just the driver's license number and photograph. In reality, the term "personal information" spans a broad array of data including name, address, date of birth, sex, height, weight, eye color, social security number, and telephone number.
  • Misconception 3: There is no fee for obtaining records. A nominal fee of $2.82 per record applies, with additional convenience fees for credit or debit card transactions and specific service fees if records are faxed.
  • Misconception 4: The form doesn't need to be notarized if submitted electronically. Regardless of the submission method, the request form must be signed and notarized, or the request will be denied.
  • Misconception 5: Any party can request someone else's driving record using this form. The form is specifically for the record holder to request their own records, with strict regulations on personal information release.
  • Misconception 6: You can only have the records sent to the address listed on your driver's license. The form allows for the records to be sent to an alternate address or via fax or email if you specify and provide the necessary information.
  • Misconception 7: The form is used exclusively for requesting driving records. Though primarily for driving records, it also offers options for requesting a clearance letter, image portfolio, and temporary driving privilege, among others.
  • Misconception 8: Credit or debit payment options are limited. The form accommodates a range of payment options including American Express, in addition to Discover, Visa, Mastercard, money order, debit card, and cash (for in-person requests).

Understanding these key points about the Missouri 4681 form can simplify the process for individuals seeking to request their driving records or other personal document information, ensuring that their needs are met efficiently and correctly.

Key takeaways

Understanding the 4681 form in Missouri is critical for anyone needing to request their driver license records. Here are some key takeaways to navigate this process smoothly:

  • Form Purpose: The 4681 form is explicitly required for individuals seeking access to their Missouri driver license records or documents containing their personal information. Without this form, your request will be denied.
  • Notarization Requirement: To ensure the authenticity of the requester, the form mandates completion, signature, and notarization. Neglecting any of these steps can result in the rejection of your request.
  • Digital Access: For those looking for a faster and more convenient route, non-restricted Missouri driver record information can be obtained online. This method bypasses the need for physical paperwork and notarization.
  • Information Sensitivity: The form distinguishes between personal and non-personal information. Sensitive details such as social security numbers require the completion of this form for access, ensuring your privacy is paramount.
  • Multiple Services: The 4681 form caters to a variety of requests, not limited to just driver record access. Services such as clearance letters and temporary driving privileges are also facilitated through this form.
  • Delivery Options: Flexibility in receiving the requested records is offered, including mail, fax, or email. It is essential to specify your preferred delivery method and provide the appropriate details.
  • Cost Implications: A fee is associated with the record request. Additionally, payment methods include a range of options but be mindful of the convenience fees for card transactions.
  • Notary Information: The form requires notarization, including a section for the Notary Public's signature and stamp. This step is crucial for validating the form.

By familiarizing yourself with these aspects, you can streamline the process of requesting your Missouri driver license records using the 4681 form. Always ensure your information is accurate and complete to avoid any delays or denials in your request.

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