Missouri Department of Revenue - Motor Vehicle Forms · Missouri state form
Form 4676 Affidavit of Lost, Destroyed, or Stolen License
Form 4676 documents a lost, destroyed, or stolen license and helps confirm identity when applying for a driver license, nondriver ID, or permit.
- What this form is
- Use Form 4676 to report a lost, destroyed, or stolen license and answer questions about possible identity impersonation. The form asks for personal and contact information, details about the identification documents presented, and the license or permit being requested. It includes a perjury declaration and a notary section. The document says to accompany the affidavit with photocopies of the listed documents; originals were witnessed by license office personnel.
- Who needs it
- A person applying for a driver license, nondriver ID, or permit whose license was lost, destroyed, or stolen and who needs to confirm identification.
- Why it needs a notary
- The form includes a notary jurat, so the signature must be notarized. This can be done online with a commissioned online notary.
- How to submit it
- Mail the completed form and photocopies of the listed documents to the Driver License Bureau, P.O. Box 200, Jefferson City, MO 65105-0200.
Questions
What is Form 4676 used for?
Form 4676 is an affidavit for a lost, destroyed, or stolen license and to confirm identification. It asks about identity impersonation and the documents presented to substantiate identity.
Does Form 4676 need to be notarized?
Yes. The form contains a “Subscribed and sworn before me” jurat and fields for a notary’s signature and commission information. You can notarize the signature online with a commissioned online notary.
Where do I mail Form 4676?
Mail the completed form and photocopies of the listed documents to the Driver License Bureau, P.O. Box 200, Jefferson City, MO 65105-0200.