Form 4803 - Request For Information
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DRIVER’S PRIVACY PROTECTION ACT (DPPA)
MISSOURI DEPARTMENT OF REVENUE
To obtain the name and address on motor vehicle and marine
MOTOR VEHICLE BUREAU - RECORD CENTER
FORM
titling and registration records, you must provide your DPPA
PO BOX 2167 JEFFERSON CITY MO 65105-2167
4803
access number in the box below. All previous owner information
(573) 526-3669
is restricted. If you do not have an access code, please request
Form 4678 from this office. Form 4678 will inform you of who
REQUEST FOR INFORMATION
(REV. 07-2013)
may receive a security access code.
PARTY REQUESTING INFORMATION
OFFICE VALIDATION
NAME - LAST, FIRST, MIDDLE INITIAL
STREET ADDRESS, R.R., OR P.O. BOX NUMBER
CITY/STATE/ZIP CODE
FAX NUMBER
(__ __ __) __ __ __ - __ __ __ __
TELEPHONE NUMBER
DPPA ACCESS NUMBER
(__ __ __) __ __ __ - __ __ __ __
OWNER INFORMATION (The owner’s address must be provided to obtain a list of motor vehicle or marine craft owned by this individual.)
NAME — LAST, FIRST, MIDDLE INITIAL
STREET ADDRESS, R.R., OR P.O. BOX NUMBER
CITY, STATE, ZIP CODE
YEAR
MAKE
TITLE NUMBER
YEAR
MAKE
DECAL NUMBER
EXPIRATION YEAR
1
1
VEHICLE IDENTIFICATION NUMBER
IDENTIFICATION NUMBER
LICENSE PLATE NUMBER
EXPIRATION YEAR
ADDITIONAL INFORMATION
YEAR
MAKE
TITLE NUMBER
YEAR
MAKE
DECAL NUMBER
EXPIRATION YEAR
2
2
VEHICLE IDENTIFICATION NUMBER
IDENTIFICATION NUMBER
LICENSE PLATE NUMBER
EXPIRATION YEAR
ADDITIONAL INFORMATION
Please check below the type of information you want to receive. A brief explanation of information this office will provide follows each type of request.
Records may be certified.
CURRENT OWNER (You must provide the license plate number or marine decal number or year, make and identification number.) You will receive only the
name and address of latest owner on file (subject to DPPA as noted above), in addition to the vehicle information and any lienholder of record.
TITLE HISTORY (You must provide the year, make and identification number.) You will receive a list that shows each time the ownership changed in this
state. The list will include the owner’s name and address (subject to DPPA as noted above) and the title number, issue date and mileage.
MILEAGE HISTORY (You must provide the year, make and identification number.) You will receive a list that shows each time the ownership changed in
this state. The list will include the mileage, title number and issue date.
STATUS OF TITLE (Free only to current vehicle owner; however, you must provide a copy of your registration receipt you received when you applied for title.)
NAME HISTORY (You must provide the owner’s name and address.) You will receive a list of the current vehicles registered in that owner’s name.
MAIL
and/or
FAX (add $0.50 per page faxed)
CHECK IF CERTIFIED RECORD REQUESTED
PLEASE SEND THE ABOVE RECORD(S) BY
CENTRAL
TOTAL RECORD FEES
CONVENIENCE FEE
PAYMENT
Records can be
FAX OR
MAIL
OFFICE
OPTIONS
E-MAIL
$0.00 - $33.00
$1.00
obtained by walk-
VISIT
in, mail-in, or e-mail
$33.01 - $100.00
3.00%
CASH
a
request.
$100.01 - $250.00
2.95%
CHECK
a
a
The fee is $5.88
$250.01 - $500.00
2.85%
MONEY ORDER
a
a
per record.
$500.01 - $750.00
2.85%
DEBIT CARD
a
A convenience fee
$750.01 - $1,000.00
2.80%
DISCOVER
a
a
a
will be charged for
$1,000.01 - $1,500.00
2.75%
VISA
a
a
a
credit/debit card
AMERICAN EXPRESS
a
a
a
$1,500.01 - $2,000.00
2.70%
transactions.
MASTERCARD
$2,000.01 or more
2.60%
a
a
a
Mail to: Motor Vehicle and Driver License Bureau-Record Center, PO Box 2167, Jefferson City, MO 65105-2167
Fax or E-Mail to: (573) 751-7060 mvrecords@dor.mo.gov
Visit at: Central Office, Harry S Truman Building, Room 370, 301 West High Street, Jefferson City, MO
If you are paying by credit/debit card you must provide the following:
NAME (AS IT APPEARS ON CARD)
CARD TYPE
CARD NUMBER
EXPIRATION DATE
__ __ / __ __
I understand that Section 302.183.2, RSMo, (HB 361 effective August 28, 2009) prohibits the sale of data derived from a person’s application for commercial purposes, which
includes purposes motivated primarily by financial gain such as, but not limited to, surveys, marketing or solicitations, without the express consent of the person to whom such
information pertains. Pursuant to Section 571.500, RSMo, requestor shall not use the information received from this request to construct, enable by providing or sharing records
to, maintain, participate in, or develop, or cooperate or enable the federal government in developing, a database or record of the number or type of firearms, ammunition, or
firearms accessories that an individual possesses.
REQUESTOR’S SIGNATURE
DATE
__ __ / __ __ / __ __ __ __
THE MISSOURI DEPARTMENT OF REVENUE MAY ELECTRONICALLY RESUBMIT CHECKS RETURNED FOR INSUFFICIENT OR UNCOLLECTED FUNDS
DOR-4803 (07-2013)
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