Form 1745 Request For Information

User Manual: 1745

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1745

Missouri Department of Revenue
Request for Information

Requestor
Information

Name

Security Access Code (if applicable)

Address

City

State

E-mail Address

Telephone Number

ZIP Code

Fax Number

(__ __ __)__ __ __-__ __ __ __
Subject
Information

Print Form

(__ __ __)__ __ __-__ __ __ __

Name As It Appears On Subject’s Current Missouri Driver License or Record

Missouri Classified License Number

Date of Birth (MM/DD/YYYY)

Address As It Appears On Subject’s Current Missouri Driver License or Record

City

State

__ __ /__ __ / __ __ __ __
ZIP Code

I hereby request the following record (please select the appropriate box(es):
The fee is $2.82 per record.

Record(s) Requested

r
r

r

Driver Record*
Case History* (A case history consists of any open case or any
reinstatement or termination case not less than two years old).

____________________________________________________
____________________________________________________

Case Document (Specify)*

r
r
r
r
r
r

Other (Specify)

____________________________________________________

Reinstatement Notice

____________________________________________________

Suspension Notice

____________________________________________________

Conviction (Ticket # ____________________)

____________________________________________________

SR-22

____________________________________________________

Image Portfolio (License Photo)

____________________________________________________

Limited Driving Privilege Package (Consists of a certified
driver record, certified SR-22, and a certified Ignition Interlock
Device (IID) if applicable).
*Records May Be Certified

Please send the above record(s) by:

____________________________________________________
____________________________________________________

r Mail
r Fax (Add $0.50 per page faxed)
r Select If Certified Record Requested

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.

Payment Options

Cash

Check

Money
Order

Debit
Card

Visa

Discover

American
Express Mastercard

Central Office Visit
Mail
Fax or E-mail

Total Record Fees
$0.00 - $50.00
$50.01 - $75.00
$75.01 - $100.00
$100.01 or more

Convenience Fee
$1.25
$1.75
$2.15
2.15%

If you are paying by credit or debit card you must provide the following:
Name (as it appears on card)

Card Type

Card Number

Expiration Date

__ __

		
Requester’s Signature

/ __ __

Printed Name

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 370, 301 West High Street, Jefferson City, Missouri.

Form 1745 (Revised 07-2016)

Mail to: Driver License Bureau
DL Record Center

Phone: (573) 526-3669				
P.O. Box 2167
Fax:
(573) 526-7367
Jefferson City, MO 65105-2167
E-mail: dlrecords@dor.mo.gov
Visit http://dor.mo.gov/drivers/records.php for additional information.



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Format                          : application/pdf
Title                           : Form 1745 - Request for Information
Creator                         : Missouri Department of Revenue
Producer                        : Adobe PDF Library 9.0
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