Missouri Department of Revenue - Motor Vehicle Forms · Missouri state form
Form 1210 Installment Agreement
Form 1210 records an installment agreement for settling a claim involving damages or personal injuries, including payment amounts, dates, and the parties’ signatures.
- What this form is
- Form 1210 is an installment agreement for a claim involving damages or personal injuries. It records accident and case information, the damaged party and person receiving payment, the total amount owed, monthly payment amount, and payment dates. The form includes declarations under penalties of perjury and notary sections, as well as an agreement about suspension of operating and registration privileges if payment defaults.
- Who needs it
- The damaged party and the driver or owner agreeing to make payments can use this form to document an installment settlement agreement.
- Why it needs a notary
- The form includes notary-required sworn declarations. The signature must be notarized; this can be done online with a commissioned online notary.
- How to submit it
- Mail the completed form to the Driver License Bureau, P.O. Box 200, Jefferson City, MO 65105-0200; fax it to (573) 526-7365; or email [email protected].
Questions
What is Form 1210 used for?
Form 1210 documents an installment agreement for settling a claim involving damages or personal injuries. It records payment terms and information about the accident and parties.
Does Form 1210 need to be notarized?
Yes. The form includes sworn declarations marked “Notary Required.” The signature must be notarized, and this can be done online with a commissioned online notary.
How can I submit Form 1210?
The form says to mail it to the Driver License Bureau in Jefferson City, fax it to (573) 526-7365, or email it to [email protected].