Form 1745 Request For Information
User Manual: 1745
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Name Security Access Code (if applicable)
Address City State ZIP Code
E-mail Address Telephone Number Fax Number
(__ __ __)__ __ __-__ __ __ __ (__ __ __)__ __ __-__ __ __ __
Form
1745 Missouri Department of Revenue
Request for Information
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.
r Driver Record*
r 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 Reinstatement Notice
r Suspension Notice
r Conviction (Ticket # ____________________)
r SR-22
r Image Portfolio (License Photo)
r 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
I hereby request the following record (please select the appropriate box(es):
The fee is $2.82 per record.
r Other (Specify)
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Payment Options
Name (as it appears on card) Card Type Card Number Expiration Date
__ __ / __ __
Requester’s Signature Printed Name
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.
If you are paying by credit or debit card you must provide the following:
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.
Cash Check Money
Order Debit
Card Discover Visa American
Express
Central Office Visit
Mail
Fax or E-mail
Mastercard
Requestor
Information
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
Subject
Information
__ __ /__ __ / __ __ __ __
Record(s) Requested
$0.00 - $50.00 $1.25
$50.01 - $75.00 $1.75
$75.01 - $100.00 $2.15
$100.01 or more 2.15%
Total Record Fees Convenience Fee
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