Fillable Printable Form 4803 - Request For Information
Fillable Printable Form 4803 - Request For Information
Form 4803 - Request For Information
Signature
Form
4803
Missouri Department of Revenue
Request for Information
Mail to:Motor Vehicle Bureau Phone: (573) 526-3669
Record Center, P.O. Box 2048 Fax: (573) 751-7060
Jefferson City, MO 65105-2048 E-mail:[email protected]
Visit //dor.mo.gov/
for additional information.
Form 4803 (Revised 07-2016)
Please select below the type of information you want to receive. A brief explanation of information this office will provide follows each type of request.
rCurrent 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.
rTitle 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.
rMileage 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.
rStatus 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.)
rName 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.
rCertified request for record information.
Requested Information
1
2
Year Make Title Number
Year Make Title Number
Vehicle Identification Number
License Plate Number Expiration Year
Vehicle Identification Number
License Plate Number Expiration Year
Motor Vehicle
1
2
Year Make Decal Number Expiration Year
Year Make Decal Number Expiration Year
Identification Number
Additional Information
Identification Number
Additional Information
Marine Craft
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
Owner
Driver’s Privacy Protection Act (DPPA) - To obtain the name and address on motor vehicle and marine titling and registration records, you must
provide your DPPA access number in the box below. All previous owner information is restricted. If you do not have an access code, please submit
a Request for Security Access Code (Form 4678). Form 4678 will inform you of who may receive a security access code.
Requester
Name of Individual or Organization Requestor’s 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
(__ __ __)__ __ __-__ __ __ __(__ __ __)__ __ __-__ __ __ __
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. The Missouri Department of Revenue may electronically resubmit
checks returned for insufficient or uncollected funds.
Requestor’s Signature Printed Name of Requestor Date (MM/DD/YYYY)
Name (as it appears on card) Card Type Card Number Expiration Date
__ __/__ __
Payment Options
Please send the above record(s) by: r Mail r Fax (Add $0.50 per page faxed)
Records can be obtained by walk-in, mail-in, or e-mail request. The fee is $2.82 per record. A convenience fee will be charged for credit or
debit card transactions.
If you are paying by credit or debit card you must provide the following:
Cash
Check
Money
Order
Debit
Card
DiscoverVisa
American
Express
Central Office Visit
Mail
Fax or E-Mail
Mastercard
__ __/__ __/__ __ __ __
$0.00 - $50.00 $1.25
$50.01 - $75.00 $1.75
$75.01 - $100.00 $2.15
$100.01 or more 2.15%
Total Record Fees Convenience Fee
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