Fillable Printable Form 4318 - Missouri Department Of Revenue
Fillable Printable Form 4318 - Missouri Department Of Revenue
Form 4318 - Missouri Department Of Revenue
You may qualify to obtain a new, renewal or duplicate permit, driver, or nondriver license if you are an active-duty member of the armed forces temporarily mobilized and deployed
outside the state of Missouri. Please complete this application and submit the required documents in order to receive a Missouri permit, driver, or nondriver license through the mail.
This application shall be considered satisfactory if it is signed by a person who holds general power of attorney executed by the person deployed, provided the applicant meets all other
requirements.
Missouri Department of Revenue
Military Application With Power of Attorney (For Persons
Mobilized and Deployed with the U.S. Armed Forces)
Motor Voter Information
Blindness Awareness Fund
Signature Box
In the past 6 months have you had:
Convulsions, Epilepsy or Blackouts rYes r No
Paralysis rYes r No
Heart Attack, Stroke, Heart Disease rYes r No
Other (If yes, please explain) rYes r No
Office Use Only
Complete both sides of this application and answer all questions that apply to you.
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New
rRenewal
rDuplicate
Medical (to be completed by applicant)
Applicant’s Signature (See Instructions Below)
I hereby certify under penalty of perjury, that all information regarding this transaction,
including my residential address furnished pursuant to Sections302.171 and 302.181
RSMo is true and accurate. (Signature must be centered in the box and not extend outside
the box.) Sign in the box below. † Black ink only.
Signature Box
Signature Box
Signature Box
Selective Service Information
Are you registered to vote at your current address? rYes r No
Do you wish to register to vote? rYes r No
(If “Yes”, complete the Motor Voter Registration Application, attached to this form, (Form
4386) and mail it to the county clerk where you reside or you may return it with Form 4318.)
Please refer to www.MissouriOrganDonor.com regarding the First Person Consent
Organ, Eye, and Tissue donor registry prior to answering the following questions.
Do you want to donate $1.00 to the organ donor fund? rYes r No
Do you consent to be listed in the Donor Registry System as an organ,
eye and tissue donor? rYes r No
Do you authorize an Organ Donor symbol to be placed on your license
or permit? rYes r No
Do you want to donate $1.00 to the Blindness Awareness Fund? rYes r No
Are you deaf or hard of hearing, and wish to add the “J88” notation to you driver license?
(If so, provide a doctor’s statement with this application.) r Yes r No
Do you wish to register with the Selective Service? rYes r No
For the purpose of signing this form, a “POA” designation is equivalent to a designation
of “attorney in fact”.
t
J88 Notation
Boater Identification Indicator
Do you wish to add or retain a boater identification indicator to your
driver license? rYes r No
If “Yes”, enter your Boating Safety Education Card control number here_________________
and add an additional $1.00 to your transaction.
Permanent Disability Indicator
Do you wish to add or retain a permanent disability indicator to your
driver license? rYes r No
If “Yes”, submit a completed Form 5294 Physician’s Statement - Permanent Disability
Indicator (available at dor.mo.gov) with this application.
Organ Donor
Form
4318
Commercial Driver License Only
Appropriate License Fee
Any person applying for a commercial driver license (CDL) must certify to one of the four categories shown below in the Self-Certification Information block indicating the type of
commercial vehicle operation they drive in or expect to drive in with their CDL.
Drivers who select “non-excepted interstate” or non-excepted intrastate” below must also submit a current medical examiner’s certificate, and any applicable waivers, with this form.
I certify my commercial operating status is-check only one box below:
(Selecting more than one box will delay processing of this form.)
rNon-excepted Interstate - (NI) Operates or expects to operate in interstate commerce
and is subject to and meets the qualification requirements under 49 CFR part 391, and
is required to obtain a medical examiner’s certificate by 49 CFR 391.45. (Current medical
examiner’s certificate, and any applicable waiver, must be submitted with this form.
rNon-excepted Intrastate - (NA) Operates only in intrastate commerce and is required
to meet Missouri’s current medical requirements. (Current medical examiner’s
certificate, and any applicable waiver, must be submitted with this form.)
rExcepted Interstate - (EI) Operates or expects to operate in interstate commerce,
but engages exclusively in transportation or operations excepted under 49 CFR
390.3(f), 391.2, 391.68, or 398.3 from all or parts of the qualification requirements
certificate by 49 CFR 391.45. These exceptions are listed in detail on the Department
of Revenue’s website at dor.mo.gov/faq/drivers/medcert.php.
rExcepted Intrastate - (EA) Operates or expects to operate in intrastate commerce,
but engages exclusively in transportation or operations that are excepted from
all parts of Missouri’s medical requirements. (This is Missouri’s grandfather
exemption where the driver operates solely in intrastate commerce and had a
valid chauffeur’s license on or before May 13, 1988.)
Have you been licensed in any other state within the past 10 years?
rYes r No
If yes, please submit a list of those states, your license number, if known, and
any alias names that you may have used while licensed in that state.
rCheck rMoney Order rCredit Card
If you are paying by credit card you must include the following:
Card type:
rDiscover rMastercard rAmerican Express rVisa
Card Number: _____________________________________________
Name on Card: ________________________ Expiration Date: (MM/YY) __ __ / __ __
Last Name First Name Middle Name Suffix Sex Missouri Driver License Number
Missouri Street Address (No PO Boxes) City State ZIP Code County
Mailing Address (If different than street address) City State ZIP Code
Out-of-State or Country Mailing Address City State or Country ZIP Code When will you return to Missouri?
Last 4 DIgits of Date of Birth Height Weight Eye Color Telephone Number
Social Security Number
E-mail Address Select the type of license you currently hold. (Select only one)
r
Class A
r
Class B
r
Class C
r
Class E
r
Class F
r
Class M
r
Male
r
Female
Reset Form
Print Form
Vision Examination Record (to be completed by eye doctor, physician, or vision examiner)
Remarks
Eye Doctor, Physician, or Vision Examiner Signature
Registration Number (if applicable)
Address
City, State, Zip Code, Country
Phone Date of Exam
( )
Both acuity and field vision readings are required.
Acuity — Your vision acuity reading must be recorded for each eye and then a combined acuity for both eyes, i.e., 20/20. The
minimum standard for a Missouri driver license is 20/40 in either or both eyes.
Field — The complete peripheral reading for each eye and a combined reading must be shown in degrees (numerics) i.e., 55°.
Do not record reading as “Full” or “Normal.” The minimum standard for a Missouri driver license is 55° in each eye or 85° in one
eye.
1. 2. 3.
4. 5. 6.
Correction20/ 20/ 20/
Without Correction20/ 20/ 20/
Horizontal Field in Degrees° ° °
HIGHWAY SIGN RECOGNITION TEST
RightLeftBothDistant Vision Only
Note: Special restrictions can be added to license if required due to visual
condition. Specify in remarks area.
Please print the correct name of each of the following signs on the line below it:
New Applicants Only
rProof of Military Active Duty or Dependent Status — Required for ALL applicants. Note: The vision examination and highway sign recognition test are waived upon
proof of status. “New” applicants must submit vision reading from physician or on Missouri State Highway Patrol Exam Form.
rName, Date of Birth, and Place of Birth — (Submit legible photocopies - not original documents):
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.
rSocial Security Number
Provide the last 4 digits of your 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.
rName 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 and current name:
Certified Marriage Certificate Certified Divorce Decree Certified Adoption Papers or Amended Birth Certificate
U.S. Passport (valid or expired) Certified Court Order Social Security Card or Medicare Card
rMissouri Residential Address
Provide proof of your Missouri residential address and mailing address. Acceptable documents include; voter registration card, utility bill, bank statement, government
check stub, pay check stub, property tax receipt, etc. (A Post Office Box will not be allowed as a residential address.)
rSigned Application Form
Complete all parts of this application and review prior to signing. Your signature (or your signature, signed by your POA, and the signature of your POA, accompanied by
a copy of the POA document) must appear within the signature box on the opposite page.
rBoater 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.
rDisability 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.
rProof of Power of Attorney - (Submit copy)
The POA must sign the applicant’s name and include the name of the POA (“Attorney in Fact”), as in the following examples:
John Doe, by Jane Doe, Attorney in FactJohn Doe, by Jane Doe, POA
rAppropriate License Fee — Required for all applicants. Payment may be made by a U.S. cashier’s check, money order, traveler’s check, personal check or credit card.
Make check or money order payable to Missouri Department of Revenue. If payment is to be made by credit card complete the credit card information section within the
application form. 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.
• Instruction Permit Class E, F, or M = $3.50 Class A, B, or C = $ 7.50
• Duplicate of an Instruction Permit Class E, F, or M = $3.50 Class A, B, or C = $ 7.50
• New Driver License (Age 21-69) Class F or M = $20.00 Class E = $35.00 Class A, B, or C = $45.00
• New Driver License (Age 18-21) Class F or M = $10.00 Class E = $17.50 Class A, B, or C = $45.00
• Nondriver License (All ages) = $11.00
• Duplicate of Nondriver License (All) = $11.00
• 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 (Age 18–21) 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 Class A, B, or C = $25.00
• Duplicate of a 3-Year Driver License Class F or M = $10.00 Class E = $17.50 Class A, B, or C = $22.50
NOTE: Add $25.00 to the above fees for each CDL written and skills test submitted.
See www.dor.mo.gov/mvdl/drivers/commercial/ to determine if you qualify for a CDL skills test waiver. Please be sure to write your driver license number on your check
or money order. If you have marked on the application that you would like to donate to either or both of the funds, you must add that donation to your fee.
Military Application with Power of Attorney
(For Persons Mobilized and Deployed with the United States Armed Forces)
You may qualify to obtain a new, renewal, or duplicate permit, driver, or nondriver license if you are an active-duty member of the armed forces temporarily mobilized
and deployed outside the state of Missouri. Please complete this application and submit the required documents in order to receive a Missouri permit, driver, or
nondriver license through the mail. This application shall be considered satisfactory if it is signed by a person who holds general power of attorney executed by the
person deployed, provided the applicant meets all other requirements.
This form is not for use by Missouri drivers who are currently in the State of Missouri.
Incomplete applications will not be accepted. You must submit the following:
Mail to:Driver License Bureau Phone: (573) 526-2407
Attention MIL Fax: (573) 751-0466
P.O. Box 200 E-mail: [email protected]
Jefferson City, MO 65105-0200
Visit //www.dor.mo.gov/drivers/
for additional information.
Form 4318 (Revised 01-2016)
The completed and signed application form, along with all required supporting documents required may be submitted by mail, fax or may be scanned and sent via email.
Applications submitted without the required supporting documents will not be processed.
MOTOR VOTER REGISTRATION APPLICATION
Use this application to:
1. Register to vote in federal, state, county, and municipal
elections in Missouri.
2. Change the name on a current voter registration.
3. Change the address on a current voter registration.
To be eligible to register to vote you must:
1. Be a U.S. Citizen.
2. Be a Missouri resident.
3. Be at least 17 1/2 years of age (must be 18 to vote).
4. Not be adjudged incapacitated by a court of law.
5.Notbeconnedunderasentenceofimprisonment.
6. Not be on probation or parole after conviction of a felony,
untilnallydischarged.
7. Not have been convicted of a felony or misdemeanor
connected with the right to suffrage.
Other information:
1. You must be 18 years of age by the day of the particular
election to be eligible to vote in that election.
2. IF YOU ARE SUBMITTING THIS FORM BY MAIL AND
ARE REGISTERING FOR THE FIRST TIME, PLEASE
SUBMIT A COPY OF A CURRENT, VALID PHOTO
IDENTIFICATION. IF YOU DO NOT SUBMIT SUCH
INFORMATION, YOU WILL BE REQUIRED TO
PRESENT ADDITIONAL IDENTIFICATION UPON VOTING
FOR THE FIRST TIME SUCH AS A BIRTH CERTIFICATE,
A NATIVE AMERICAN TRIBAL DOCUMENT, OTHER
PROOF OF UNITED STATES CITIZENSHIP, A VALID
MISSOURI DRIVERS LICENSE OR OTHER FORM OF
PERSONAL IDENTIFICATION.
3. Submitting this application to an individual other than the
election authority does not insure timely voter registration.
4. After the election authority receives your voter registration
application,youwillbesentconrmationwithinseven
businessdays.Ifyoudonotreceiveconrmationcontactthe
election authority.
5. If you wish to serve as an election judge on election day
please contact your local election authority.
Absentee Voting
Registered voters who are unable to go to the polls on election
day may vote via absentee ballot. This process begins six weeks
before the election. Individuals wishing to vote by absentee ballot
must make their application in writing, stating the reason they will be
prevented from going to the polls on election day. Voters wishing to
have their absentee ballot mailed to them must have their request
intheofceofelectionauthoritynolaterthan5:00p.m.onthe
Wednesday before the election. The voter may however continue
tovoteviaabsenteeinperson,intheofceoftheelectionauthority
until5:00p.m.thedaybeforetheelection.Forinformationabout
requesting an absentee ballot contact your local election authority
or visit the Missouri Secretary of State website at ww.sos.mo.gov/.
YOUR APPLICATION WILL BE CONFIRMED BY MAIL WITHIN SEVEN (7) BUSINESS DAYS OF RECEIPT BY THE ELECTION
AUTHORITY. PLEASE CONTACT THE ELECTION AUTHORITY IF YOU DO NOT RECEIVE NOTIFICATION.
(DETACHHERE-KEEPTOPPORTIONFORYOURRECORDS)Thiscardisnotproofofregistration.
MISSOURIDEPARTMENTOFREVENUE
MOTOR VOTER REGISTRATION APPLICATION
Driver License Bureau
3r NEW REGISTRATION r ADDRESS CHANGE r NAME CHANGE FOR OFFICE USE ONLY REGISTRATION NO
4LASTNAMEFIRSTNAMEMIDDLENAMESUFFIXSEX
5ADDRESSWHEREYOULIVE(HOUSENO.,STREET,APT.NO.ORRURALROUTEANDBOX-NOPOBOXES)CITYCOUNTYZIPCODE
6ADDRESSWHEREYOUGETYOURMAIL(REQUIREDIFDIFFERENTFROM#5ABOVE)CITYSTATEZIPCODE
7DRIVER LICENSE NUMBER 8
LAST4DIGITSOFSOCIALSECURITYNUMBER*
IFYOUDONOTHAVEASOCIALSECURITYNUMBER,PLEASELEAVEBLANK___________________________
9
DATEOFBIRTH(MM/DD/YY)
10
PLACEOFBIRTH(OPTIONAL)
11
DAYTIME PHONE NO. (OPTIONAL)
12NAMEANDADDRESSONLASTVOTERREGISTRATION**13
NAME ___________________________________________________________________________________
ADDRESS ________________________________________________________________________________
CITY _______________________________________STATE ____________________________________
COUNTY__________________________________________________________________________________
**Ifcurrentlyregisteredinanotherstateorcountypleasecompletethisbox
14RURALVOTERS:COMPLETETHISSECTIONIFYOULIVEOUTSIDETHECITYLIMITSOFANYCITY
I live ___________________________________________________________miles N S E W (circle one) of
____________________________________________________________landmark or junction (circle one) of
Section, Township, and range _________________________________________________________________
My neighbors are ___________________________________________________________________________
rCheck here if you are interested in working as an Election Judge Warning:Convictionformakingafalsestatementmayresultinimprisonmentforuptoveyearsand/oraneupto$10,000.
FORM
4386
I hereby certify that I am a citizen of the United States and a resident
of the state of Missouri. I am at least seventeen and one half years of
age. I have not been adjudged incapacitated by any court of law. If I
have been convicted of a felony or a misdemeanor connected with the
right of suffrage, I have had the voting disabilities resulting from such
conviction removed pursuant to law. I swear under penalty of
perjury that all statements made on this card are true to the best of my
knowledge and belief. I understand that if I register to vote knowing that
I am not legally entitled to register, I am committing a class one election
offenseandmaybepunishedbyimprisonmentofnotmorethanve
yearsorbyanebetweentwothousandvehundreddollarsandten
thousanddollarsorbybothsuchimprisonmentandne.
Date Signature
*RequiredforregistrationpursuanttoSection115.155,RSMoandSection115.158,RSMoandwillbeusedonlybyauthorizedofcialstocombatvoterfraudandfacilitateorderlyelections.
Form4386(Revised02-2006)
r Male rFemale
If you checked no in response to either of the above questions, do not complete this form.
1AREYOUACITIZENOFTHEUNITEDSTATESOFAMERICA?r Yes r No2WILLYOUBE18YEARSOLDONORBEFOREELECTIONDAY?r Yes r No
If not completing electronically, please use a pen and print clearly.
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