Form 4317-Mail-In Driver License Application-Missouri Department Of Revenue Driver License Bureau Page 2

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MAIL-IN DRIVER LICENSE APPLICATION AND INSTRUCTIONS

(ACTIVE DUTY MILITARY PERSONNEL AND MILITARY DEPENDENTS ONLY)

YOU MAY QUALIFY TO RENEW OR REPLACE YOUR MISSOURI DRIVER LICENSE IF YOU ARE TEMPORARILY OUT-OF-STATE/COUNTRY.

PLEASE READ ALL INSTRUCTIONS BEFORE COMPLETING THE FORM. YOUR MAIL-IN LICENSE APPLICATION WILL BE PROCESSED

WITHIN 7-10 DAYS FROM THE DATE IT IS RECEIVED IN OUR OFFICE.

THIS FORM IS NOT FOR USE BY MISSOURI DRIVERS WHO ARE CURRENTLY IN THE STATE OF MISSOURI.

THIS FORM IS ALSO NOT VALID TO RENEW OR REPLACE A “VALID WITHOUT PHOTO” (VWP) DRIVER LICENSE, EXCEPT FOR ACTIVE

DUTY U.S. MILITARY PERSONNEL. ALL OTHER VWP APPLICANTS MUST RETURN TO MISSOURI TO APPLY FOR A NEW LICENSE.

INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. YOU MUST SUBMIT THE FOLLOWING:

PROOF OF MILITARY ACTIVE DUTY/DEPENDENT STATUS (such as photocopy of military photo ID)

— Required for ALL applicants. Note:

The vision examination and highway sign recognition test are waived upon proof of status.

NAME, DATE OF BIRTH, AND PLACE OF BIRTH

— (Submit copies):

U.S. Citizen: U.S. Birth Certificate, U.S. Passport, Certificate of Citizenship, Certificate of Naturalization or Certificate of Birth Abroad. U.S. Military

Identification Card or Discharge Papers accompanied by a copy of U.S. Birth Certificate issued by a state or local Government. Non-U.S. Citizen:

Document(s) indicating current immigration status such as permanent resident alien card, I-94, etc. Expiration date of document will be determined

by expiration date of status per verification through the Department of Homeland Security. Age 65 and Older Exemption — If you are renewing a

non-commercial driver license and are age 65 or older, you are exempt from presenting documents for place of birth.

SOCIAL SECURITY NUMBER

Provide a social security number in the appropriate box on this form if a number has been assigned to you; or if a number has not been assigned,

you must present a letter from the Social Security Administration (SSA) regarding the status of your Social Security Number.

NAME CHANGE (if applicable)

— Due to marriage, divorce, adoption, etc.

If your current name is different from the name on your name verification document presented above or your previous name on your Missouri record,

you must submit a copy of one of the following documents reflecting the correct/current name:

Certified Marriage Certificate

Certified Adoption Papers or Amended Birth Certificate

Certified Divorce Decree

U.S. Passport (valid or expired)

Certified Court Order

Social Security Card/Medicare Card

MISSOURI RESIDENTIAL ADDRESS

Please review the perjury statement prior to signing this application. Completion of the resident and mailing address on this form and your signature

will meet residency verification requirements for this application. (A Post Office Box will not be allowed as a residential address.)

APPLICATION FORM

Complete all parts of this application and review prior to signing. Your signature (or the signature of your POA, accompanied by a copy of the

POA document) must appear within the signature box on the opposite page.

BOATER IDENTIFICATION INDICATOR

If you have been issued a boating safety education card by the Missouri State Water Patrol under section 306.127, RSMo, you may elect to have a

boater identification indicator placed on the back of your driver license. To have the indicator added to your document, you must submit the control

number from your Boating Safety Education Card and add an additional $1.00 to your transaction.

If your current license has a boater identification indicator, you may elect to retain the indicator on your new or renewal document. There is no

additional cost to retain a previously issued indicator.

PERMANENT DISABILITY INDICATOR

If you are permanently disabled, you may apply for a permanent disability indicator indicating such status to be placed on the back of your driver or

nondriver license. To have the indicator added to your document, you must submit Form 5294 Physician’s Statement - Permanent Disability Indicator.

If your current license has a permanent disability indicator, you may elect to retain the indicator on your new or renewal document. A new physician’s

statement is not required.

APPROPRIATE LICENSE FEE

— Required for ALL applicants. Payment may be made by a U.S. cashier’s check, money order, traveler’s

check, or personal check.

NOTE: If your driver license is within six months of expiring when the mail-in application is received in our office, the transaction is processed as a

renewal.

• RENEWAL driver license (Age 21-69)

Class F or M = $20.00

Class E = $35.00

Class A, B, or C = $45.00

• RENEWAL driver license (All other ages)

Class F or M = $10.00

Class E = $17.50

Class A, B, or C = $22.50

• DUPLICATE of a 6-year driver license

Class F or M = $12.50

Class E = $20.00