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2. WHAT IS THIS FORM FOR?

   This form is for any defendant who is required to provided proof of insurance to the Court. This form is NOT for attorneys working with the Prosecutor. 

4. WHAT HAPPENS AFTER I SUBMIT MY FORM?

   After your proof of insurance has been submitted, it will be reviewed by the Court. You will be contacted by the email or phone number provided with additional information regarding your case. If you don't receive anything from the Court within 2 business days, please contact us immediately to ensure there are not any errors with your submission. 

   DO NOT ASSUME YOUR CASE HAS BEEN CLOSED AFTER COMPLETING THE FORM.

6. HOW DO I LOOK UP MY CASE/COURT DATE?

   Your can look up information or sign up for alerts regarding your case online at www.courts.mo.gov/ticket.

8. First Name*
9. Last Name*
11. Ticket / Case Number*

    Case numbers should be for failure to provide proof of insurance only.

12. Upload Proof of Insurance *

    Provide a copy of the insurance card or deck page that covers the date of your violation.

14. Mailing Address (Street)*
16. City *
17. State*
18. Zip*
20. Phone*
21. Email*
23. Additional Information
25. I agree and understand*

    1. This form is to be used to provide proof of insurance that covers the violation date listed on my ticket.
27. I agree and understand*

    1. Submission of this form does not close out a case. It is my responsibility to contact the court if I have not received a response with in 2 business days after the date submitted.
29. Signature

    DISCLAIMER: By typing your name below, you are signing this form electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.

31. First & Last Name*
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field