Fillable NAME OR ADDRESS CHANGE FORM

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NAME OR ADDRESS CHANGE FORM

On average this form takes 6 minutes to complete

The NAME OR ADDRESS CHANGE FORM form is 1 page long and contains:

  • 0 signatures
  • 5 check-boxes
  • 20 other fields

Country of origin: OTHERS
File type: PDF

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If your business owners, business type or tax id have changed, your name cannot be changed using this form.
YOU MUST FILL OUT AN MO-1 APPLICATION AND REQUEST A TRANSFER OF YOUR OPERATING AUTHORITY.
If you are unsure if your name change requires a transfer of authority please contact our office at the number above for guidance.
The following sources must reflect the new legal and/or DBA name in order to process your request:
SECTION 1 - NAME CHANGE
I have updated my Legal and/or DBA name with the FMCSA (USDOT)
I have updated my Legal and/or DBA name with the Missouri Secretary of State (if applicable)
NAME OR ADDRESS CHANGE FORM
I have requested a new insurance filing from my insurance company with updated info to MoDOT MCS
USDOT NO:
PRIOR LEGAL NAME
PRIOR DBA NAME
NEW LEGAL NAME
NEW DBA NAME
SECTION 2 - ADDRESS CHANGE
CARRIER NAME
NEW PRINCIPAL PLACE OF BUSINESS:
STREET
STATE
ZIP
NEW BUSINESS MAILING ADDRESS:
CITY
ZIP
STATECITY
STREET
The following sources must reflect the new address in order to process your request:
I have updated my address with the FMCSA (USDOT)
I have requested a new insurance filing from my insurance company with updated info to MoDOT MCS *
*Note: if only your street address has changed (the city located on your current insurance form is the same), we do not need an updated insurance filing
SECTION 3 - SIGNATURE
APPLICANT SIGNATURE
DATE
PHONE
PRINTED NAME
TITLE
MISSOURI DEPARTMENT OF TRANSPORTATION
MOTOR CARRIER SERVICES
PO BOX 270, 830 MODOT DRIVE
JEFFERSON CITY, MO 65102-0270
PHONE: 573.751.3358
FAX: 573.522.6708
TOLL FREE: 866.831.6277 (option 3)
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NAME OR ADDRESS CHANGE FORM

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Completed 20 July 2020

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