Form 4317 - Vwp License Application - Missouri Department Of Revenue
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1
2MISSOURI DEPARTMENT OF REVENUE
OFFICE USE ONLY
FORM
DRIVERS LICENSE BUREAU
DATE
4317
P.O. BOX 200
JEFFERSON CITY, MO 65105-0200
TIS
(REV 12-97)
VWP LICENSE APPLICATION
Please complete this application and submit the documents listed in order to receive a Missouri license without a
photograph.
COMPLETE THE FOLLOWING
NAME
MISSOURI DRIVER'S LICENSE / SOCIAL SECURITY NUMBER
DATE OF BIRTH
MISSOURI ADDRESS
OUT-OF-STATE MAILING ADDRESS
CITY
STATE
ZIP CODE
CITY, STATE, ZIP CODE
HEIGHT
WEIGHT
EYE COLOR
WHEN WILL YOU RETURN TO MISSOURI?
OFFICE USE ONLY
CHECK ALL THAT APPLY
MILITARY
MILITARY DEPENDENT
VISITING
EMPLOYMENT
TDP
LICENSE
STUDENT
YOU MUST SUBMIT THE FOLLOWING DOCUMENTS WITH THIS APPLICATION TO THE ADDRESS LISTED ABOVE
1. Appropriate License Fee. Class A, B or C - $20, Class E - $15, Class F or M - $7.50. Payment can be made by
cashier's check or money order.
2. Vision Examination Results. Vision acuity and peripheral field vision readings are required. Vision examination
information is located on the reverse side of this form. Vision exam is not required on a duplicate transaction.
NOTE: Active duty military personnel/dependents may submit a copy of their military ID card in lieu of a vision exam.
3. Proof of Social Security Number (SSN). Acceptable documents include: Social Security Card; W-2 form; paycheck
stub (name and social security number must be printed in the same style); and/or letter from the Social Security Office
on its letterhead. Complete the SSN objector information on the back of this form if you do not wish to use your SSN
as your driver's license number. NOTE: If you are applying for a Class A, B or C license, you may object only for
religious reasons.
4. Proof of identity. Acceptable documents include originals or copies of one of the following: Missouri driver's or
nondriver's license; military or military dependent photo identification card; birth certificate issued by a state, city,
county or hospital; passport; adoption papers; immigration documents; citizenship/naturalization documents; military
discharge papers; or prison release documents.
CHANGES OR CORRECTIONS TO DRIVER'S LICENSE INFORMATION
If you wish to change information or make a correction to any information contained on the face of your license, you must
submit the original or a certified true copy of the following documentation:
Name Change - Birth certificate, marriage certificate, divorce decree or court order.
Date of Birth - Birth certificate or court order.
Social Security Number -
Social Security Card, W-2 form, paycheck stub (name and social security number must be
printed in the same style), and/or letter from the Social Security Office on its letterhead.
Class of License or Endorsement - Appropriate written and/or skills test results.
Restriction - Appropriate test results.
I CERTIFY UNDER PENALTY OF PERJURY THAT THE
APPLICANT'S SIGNATURE
INFORMATION ABOVE IS TRUE AND CORRECT TO THE BEST
OF MY KNOWLEDGE.
CALL (573) 751-2730 IF YOU HAVE QUESTIONS
MO 860-2508 (12-97)
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