Form 4202 - Affidavit Of No Unsatisfied Judgments

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Missouri Department of Revenue
Form
4202
Affidavit of No Unsatisfied Judgments
I, the undersigned, being first duly sworn, depose and state that there are no unsatisfied judgments against me in the county where I
reside.
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
Signature
Printed Name
Date (MM/DD/YYYY)
__ __ / __ __ / __ __ __ __
Address
City
State
Zip Code
County
Subscribed and sworn before me, this
Embosser or black ink rubber stamp seal
day of
year
State
County (or City of St. Louis)
My Commission Expires
Notary Public Signature
Notary Public Name (Typed or Printed)
Form 4202 (Revised 05-2013)
Mail to:
Driver License Bureau
Phone: (573) 751-7195
Visit dor.mo.gov/drivers/
301 West High Street, Room 470
Fax:
(573) 526-7365
for additional information.
Jefferson City, MO 65105-0200
E-mail: dlbmail@dor.mo.gov

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