Missouri Department of Revenue - Motor Vehicle Forms · Missouri state form
Form 4999 Affidavit for Return of Securities
Form 4999 is an affidavit declaring information about service of legal papers, unsatisfied judgments, and motor vehicle accidents for a securities return request.
- What this form is
- Use Form 4999 to declare that you have not been served as a defendant in an action of law, have no unsatisfied judgments for injuries or damages from a motor vehicle accident, and have not been involved as an operator or owner in a qualifying accident during the preceding year. The form includes a perjury declaration and a notarial section.
- Who needs it
- A person making the declarations on Form 4999 for the return of securities may complete and submit this affidavit to the Driver License Bureau.
- Why it needs a notary
- The form includes a notary jurat and states “Notary Required.” The signature must be notarized; this can be done online with a commissioned online notary.
- How to submit it
- Mail the completed form to Driver License Bureau, 301 West High Street, Room 470, P.O. Box 200, Jefferson City, MO 65105-0200.
Questions
What is Form 4999 used for?
Form 4999 is an affidavit for return of securities. It asks the signer to declare information about service as a defendant, unsatisfied judgments, and motor vehicle accidents.
Who completes Form 4999?
A person making the statements on the affidavit completes and signs the form, including the declaration under penalties of perjury.
Does Form 4999 need to be notarized?
Yes. The form includes a jurat and says “Notary Required.” The signature must be notarized, including online with a commissioned online notary.