Form 1745 Request For Information

User Manual: 1745

Open the PDF directly: View PDF PDF.
Page Count: 1

DownloadForm 1745 - Request For Information
Open PDF In BrowserView PDF
Reset Form
Form

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.
Source Exif Data: 
File Type                       : PDF
File Type Extension             : pdf
MIME Type                       : application/pdf
PDF Version                     : 1.7
Linearized                      : Yes
Author                          : Missouri Department of Revenue
Create Date                     : 2014:06:02 12:14:47-05:00
Modify Date                     : 2017:02:28 07:32:43-06:00
Has XFA                         : No
Tagged PDF                      : Yes
XMP Toolkit                     : Adobe XMP Core 5.4-c006 80.159825, 2016/09/16-03:31:08
Metadata Date                   : 2017:02:28 07:32:43-06:00
Creator Tool                    : Adobe InDesign CS4 (6.0)
Thumbnail Format                : JPEG
Thumbnail Width                 : 256
Thumbnail Height                : 256
Thumbnail Image                 : (Binary data 12620 bytes, use -b option to extract)
Instance ID                     : uuid:00f8c571-5412-4053-bd67-5137bcf9aae2
Document ID                     : xmp.did:9CC8552F29BBE31187E9911F72BCB5E8
Original Document ID            : xmp.did:EB320D6B7351E011A12DB2E6707ACDF0
Rendition Class                 : proof:pdf
History Action                  : created, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved, saved
History Instance ID             : xmp.iid:EB320D6B7351E011A12DB2E6707ACDF0, xmp.iid:EC320D6B7351E011A12DB2E6707ACDF0, xmp.iid:ED320D6B7351E011A12DB2E6707ACDF0, xmp.iid:CB5D401F837DE011A8FA867AEA918B0D, xmp.iid:CC5D401F837DE011A8FA867AEA918B0D, xmp.iid:2D0D2CEAEEB2E011B03AAD50F9CAB4E8, xmp.iid:2E0D2CEAEEB2E011B03AAD50F9CAB4E8, xmp.iid:AF72019366B4E01187DF96BBE1148DB0, xmp.iid:B072019366B4E01187DF96BBE1148DB0, xmp.iid:C464BB3982B8E0118BC1E35670D23234, xmp.iid:C564BB3982B8E0118BC1E35670D23234, xmp.iid:C664BB3982B8E0118BC1E35670D23234, xmp.iid:34B0FEB836B9E011878DA98707B6FD7F, xmp.iid:B4BD3C9596BCE2119256879420DEE60D, xmp.iid:581809E6B277E311B988CEB27C44DFF5, xmp.iid:06637F00439AE311B3D8BA1FBF7232EF, xmp.iid:07637F00439AE311B3D8BA1FBF7232EF, xmp.iid:08637F00439AE311B3D8BA1FBF7232EF, xmp.iid:09637F00439AE311B3D8BA1FBF7232EF, xmp.iid:0A637F00439AE311B3D8BA1FBF7232EF, xmp.iid:0B637F00439AE311B3D8BA1FBF7232EF, xmp.iid:8FFA00D5069BE3118E078ADB48099AE3, xmp.iid:90FA00D5069BE3118E078ADB48099AE3, xmp.iid:91FA00D5069BE3118E078ADB48099AE3, xmp.iid:6444A4BF1B9BE3118E078ADB48099AE3, xmp.iid:6544A4BF1B9BE3118E078ADB48099AE3, xmp.iid:6644A4BF1B9BE3118E078ADB48099AE3, xmp.iid:6744A4BF1B9BE3118E078ADB48099AE3, xmp.iid:6944A4BF1B9BE3118E078ADB48099AE3, xmp.iid:6D44A4BF1B9BE3118E078ADB48099AE3, xmp.iid:6E44A4BF1B9BE3118E078ADB48099AE3, xmp.iid:89DFFF47349BE3118E078ADB48099AE3, xmp.iid:2ACBCE0B559DE3118D1FE85AF4031959, xmp.iid:5F42F337109FE311BB1C8544F699C336, xmp.iid:6042F337109FE311BB1C8544F699C336, xmp.iid:795217BDF0B4E311B338891EDDBFD3AD, xmp.iid:7A5217BDF0B4E311B338891EDDBFD3AD, xmp.iid:4136311A17B5E31192848C76B31CB28B, xmp.iid:3284CDD089B6E311A62DC5CA6A6D3A16, xmp.iid:3384CDD089B6E311A62DC5CA6A6D3A16, xmp.iid:3484CDD089B6E311A62DC5CA6A6D3A16, xmp.iid:3584CDD089B6E311A62DC5CA6A6D3A16, xmp.iid:064D5E048DB6E311B5C0E1A6D6C6AC81, xmp.iid:AB099365D9B8E311A695DA0673CD9BDD, xmp.iid:AC099365D9B8E311A695DA0673CD9BDD, xmp.iid:AD099365D9B8E311A695DA0673CD9BDD, xmp.iid:675D6EC9DAB8E3119077D0DEAF8AF059, xmp.iid:685D6EC9DAB8E3119077D0DEAF8AF059, xmp.iid:0F88744ADBB8E311B3EACE7F8B6EA1CE, xmp.iid:733B3B80DBB8E311AAADC4376C31B178, xmp.iid:9BC8552F29BBE31187E9911F72BCB5E8, xmp.iid:9CC8552F29BBE31187E9911F72BCB5E8, xmp.iid:033DA18343BBE311B780812D8F1AC890, xmp.iid:3016DD3679EAE311B9E7A8FA276F2852, xmp.iid:7A6DB26279EAE311AE39EF007E739A86
History When                    : 2011:03:18 10:21:38-05:00, 2011:03:18 10:22:25-05:00, 2011:03:18 10:22:25-05:00, 2011:05:13 14:50:01-05:00, 2011:05:13 14:50:28-05:00, 2011:07:20 12:17:26-05:00, 2011:07:20 14:04:03-05:00, 2011:07:22 09:58:30-05:00, 2011:07:22 10:01:55-05:00, 2011:07:27 14:46:32-05:00, 2011:07:27 14:48:44-05:00, 2011:07:27 15:18:55-05:00, 2011:07:28 12:42:46-05:00, 2013:05:14 08:02:50-05:00, 2014:01:07 09:46:39-06:00, 2014:02:20 13:28:05-06:00, 2014:02:20 13:34:07-06:00, 2014:02:20 13:40:36-06:00, 2014:02:20 13:45:22-06:00, 2014:02:20 14:15:43-06:00, 2014:02:20 15:02:33-06:00, 2014:02:21 09:51:51-06:00, 2014:02:21 10:39:36-06:00, 2014:02:21 11:03:08-06:00, 2014:02:21 11:15:23-06:00, 2014:02:21 11:28:13-06:00, 2014:02:21 12:13:53-06:00, 2014:02:21 13:19:46-06:00, 2014:02:21 13:42:48-06:00, 2014:02:21 13:59:20-06:00, 2014:02:21 14:07:08-06:00, 2014:02:21 14:10:59-06:00, 2014:02:24 07:10:34-06:00, 2014:02:26 13:52:32-06:00, 2014:02:26 13:53:10-06:00, 2014:03:26 09:13-05:00, 2014:03:26 09:17:37-05:00, 2014:03:26 13:47:37-05:00, 2014:03:28 10:01:18-05:00, 2014:03:28 10:05:52-05:00, 2014:03:28 10:08:40-05:00, 2014:03:28 10:09:51-05:00, 2014:03:28 10:24:13-05:00, 2014:03:31 08:36-05:00, 2014:03:31 08:43:03-05:00, 2014:03:31 08:43:15-05:00, 2014:03:31 08:45:57-05:00, 2014:03:31 08:48:06-05:00, 2014:03:31 08:49:33-05:00, 2014:03:31 08:51:03-05:00, 2014:04:03 09:13:55-05:00, 2014:04:03 09:13:55-05:00, 2014:04:03 10:20:39-05:00, 2014:06:02 12:13:28-05:00, 2014:06:02 12:14:41-05:00
History Software Agent          : Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0, Adobe InDesign 6.0
History Changed                 : /, /metadata, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /, /metadata, /;/metadata, /, /, /
Derived From Instance ID        : xmp.iid:9BC8552F29BBE31187E9911F72BCB5E8
Derived From Document ID        : xmp.did:EB320D6B7351E011A12DB2E6707ACDF0
Derived From Original Document ID: xmp.did:EB320D6B7351E011A12DB2E6707ACDF0
Derived From Rendition Class    : default
Manifest Link Form              : ReferenceStream, ReferenceStream
Manifest Placed X Resolution    : 301.00, 96.00
Manifest Placed Y Resolution    : 301.00, 96.00
Manifest Placed Resolution Unit : Inches, Inches
Manifest Reference Instance ID  : uuid:2859679E503BE311B57E9A3922B7256B, uuid:faf5bdd5-ba3d-11da-ad31-d33d75182f1b
Manifest Reference Document ID  : uuid:27F066E87874E2119D288F064CD9D5B8
Doc Change Count                : 6252
Format                          : application/pdf
Title                           : Form 1745 - Request for Information
Creator                         : Missouri Department of Revenue
Producer                        : Adobe PDF Library 9.0
Trapped                         : False
State                           : 1
Version                         : 1.1
Page Count                      : 1
Signing Date                    : 2017:02:28 07:32:43-06:00
Signing Authority               : ARE Acrobat Product v8.0 P23 0002337
Annotation Usage Rights         : Create, Delete, Modify, Copy, Import, Export
Document Usage Rights           : FullSave
Form Usage Rights               : Add, FillIn, Delete, SubmitStandalone
Signature Usage Rights          : Modify
EXIF Metadata provided by EXIF.tools

Navigation menu