Form 4160 - Address Change Request Form

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IMPORTANT NOTE:
FORM
YOU MAY COMPLETE THIS FORM TO UPDATE
MISSOURI DEPARTMENT OF REVENUE
PO BOX 100
4160
YOUR MAILING ADDRESS IN OUR FILES.
JEFFERSON CITY MO 65105-0100
IF HANDWRITING THE INFORMATION,
(REV. 04-2012)
ADDRESS CHANGE REQUEST FORM
PLEASE PRINT CLEARLY.
NAME
NAME (LAST, FIRST, MIDDLE)
BIRTHDATE (MM/DD/YYYY)
LAST FOUR DIGITS OF YOUR SOCIAL SECURITY NUMBER
_ _ / _ _ / _ _ _ _
__ __ __ __
OLD ADDRESS INFORMATION (OPTIONAL)
NEW ADDRESS INFORMATION
MAILING ADDRESS
MAILING ADDRESS
CITY
CITY
COUNTY
STATE
ZIP CODE
COUNTY
STATE
ZIP CODE
__ __ __ __ __
__ __ __ __ __
SIGNATURE
DAYTIME TELEPHONE NUMBER
E-MAIL ADDRESS
( ___ ___ ___ ) ___ ___ ___ – ___ ___ ___ ___
RECORDS TO BE UPDATED
Driver License Record Address Change Questions: (573) 751-2730
DRIVER LICENSE RECORDS
NAME (LAST, FIRST, MIDDLE)
DRIVER LICENSE NUMBER
This change also includes instruction permits and nondriver licenses. NOTE: You must complete a Driver License Application at a Missouri License
Office if you want your Missouri driver license, permit or non-driver license to reflect your new address.
Individual Income Tax Address Change Questions: (573) 751-3505
INDIVIDUAL INCOME TAX RECORDS
Motor Vehicle Record Address Change Questions: (573) 526-3669
MOTOR VEHICLE RECORDS
LIST ALL PASSENGER CAR, TRUCK, RECREATIONAL VEHICLE,
LIST ALL DISABLED PLACARDS BELOW:
MOTORCYCLE AND TRAILER PLATES BELOW:
DISABLED PLACARD NUMBER
EXP. YEAR
LICENSE PLATE NUMBER
EXP. YEAR
LIST ALL BOAT OR OUTBOARD TITLE NUMBERS BELOW:
BOAT OR OUTBOARD MOTOR TITLE NUMBER
Business Tax Address Change Questions: (573) 751-5860
BUSINESS TAX RECORDS
To request a change of address for a business, complete a Registration Change Request (Form 126),
which can be obtained on our web site at:
FOR MORE INFORMATION, VISIT OUR WEB SITE AT:
DOR-4160 (04-2012)

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