Form 4160 - Address Change Request
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Missouri Department of Revenue
Form
4160
Address Change Request
Name (Last, First, Middle)
Birthdate (MM/DD/YYYY)
Last four digitis of your social security number Daytime Telephone Number
-
(
)
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___ ___
Mailing Address
Mailing Address
City
City
County
State
Zip Code
County
State
Zip Code
r
Driver License Records
- This change also includes instruction permits and nondriver licenses. Note: You must complete a Driver License
4317) at a Missouri License Office if you want your Missouri driver license, permit, or non-driver license to reflect your new
Application
(Form
address. Driver license record address change questions: (573) 751-2730
Name (Last, First, Middle)
Driver License Number
r
Individual Income Tax Records
-
Individual income tax address change questions: (573) 751-3505
r
Motor Vehicle Records -
Motor vehicle record address change questions: (573) 526-3669
List all passenger car, truck, recreational vehicle, motorcycle and
List all disabled placards below:
trailer plates below:
License Plate Number
Disabled Placard Number
Exp. Year
Exp. year
List all boat or outboard title numbers below:
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 website at dor.mo.gov/forms/126.pdf. Business tax address change questions: (573) 751-5860
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
Signature
Printed Name
E-mail Address
Date (MM/DD/YYYY)
___ ___ / ___ ___ / ___ ___ ___ ___
Form 4160 (Revised 07-2013)
Mail to:
Missouri Department of Revenue
E-mail: dormail@dor.mo.gov
P.O. Box 100
Jefferson City, MO 65105-0100
Visit
dor.mo.gov/howdoi/addchange.php
for additional information.
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