Form 1210, Installment Agreement, is the Missouri Department of Revenue form that puts a payment plan for an accident damage claim in writing. The driver, and the vehicle owner when different, agree to pay the damaged party, and the person receiving payment accepts the terms. Each side signs before a notary, and the form is mailed to the Driver License Bureau. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the original is published by the Department at dor.mo.gov.
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What is 1210?
Form 1210, Installment Agreement, is the Missouri Department of Revenue form that records an agreement under which a driver, or the vehicle owner, pays a damaged party in monthly payments to settle a claim for damages and/or personal injuries from an accident.
The form identifies the accident (case number, city or county, state and date), names the damaged party and the person receiving payment, and sets the payment terms: total amount owed, monthly payment amount, date of first payment and final payment date. It also records the driver's license number and date of birth of the driver and, if different, of the owner.
Two sworn declarations make it an agreement. The party agreeing to pay declares under penalties of perjury that the information is true, complete and correct and agrees to settle the claim. The party receiving payment makes the same declaration and accepts the agreement. Each block has a notary section.
The form states a consequence: under the Missouri Financial Responsibility Law, upon notice of default in the agreement by the party or parties agreeing to make payment, the operating and registration privileges will be suspended.
Do not confuse it with other Department forms that carry similar names. The Department's Forms and Manuals page lists Form 4338, Tax Payment Installment Agreement Request, and Form 5708, Hardship Installment Agreement Application, as separate forms. Form 1210 is the one with accident fields, and it is returned to the Driver License Bureau. The Department lists it among its Motor Vehicle Forms.
Who needs to file 1210?
The people who use Form 1210 are the parties to an accident damage settlement paid in installments.
- The driver (the party agreeing to pay) provides a driver license number and date of birth, and signs the first declaration.
- The vehicle owner, if different from the driver, provides the owner's driver license number and date of birth, and also signs as a party agreeing to pay.
- The damaged party and the person receiving payment are named on the form. The party receiving payment signs the second declaration to accept the agreement; the form has two signature lines for that side.
Every signature block carries a Notary Required note, so each signer must be able to appear before a notary public.
The form does not say that anyone else may sign for a party. It is not the form for a payment plan on a tax debt; the Department lists Forms 4338 and 5708 separately for that kind of request.
When to file 1210
The form is completed once the parties have agreed on the total amount, the monthly payment, the first payment date and the final payment date for a claim for damages and/or personal injuries from an accident. Form 1210 prints no filing deadline of its own.
Both sides must sign and have their signatures sworn before a notary, so allow time for the driver (and owner) and the person receiving payment to each meet a notary. The form warns that, on notice of default in the agreement, operating and registration privileges will be suspended under the Missouri Financial Responsibility Law. Keep the payment dates you enter realistic, since they define the agreement. For questions about timing in your situation, call the Driver License Bureau at (573) 751-7195.
How to fill out 1210
Enter the case number
At the top of the form, write the Case Number that applies to the accident claim.
Give the accident location and date
Enter the City or County of Accident and the State of Accident. Enter the Accident Date in MM/DD/YYYY format.
Name the parties
Under Agreement Information, enter the Damaged Party and the Person Receiving Payment.
Enter the payment terms
Fill in Total Amount Owed, Monthly Payment Amount, Date of First Payment and Final Payment Date, using the MM/DD/YYYY pattern for the dates.
Enter the driver's details
Write the Driver's Driver License Number and the Driver's Date of Birth in MM/DD/YYYY format.
Add owner details if different
Only if the vehicle owner is not the driver, enter the Owner's Driver License Number and Owner's Date of Birth. Otherwise leave these lines blank.
Sign for the party agreeing to pay
The driver signs under Driver's Signature (Party Agreeing to Pay), and the owner signs under Owner's Signature, if different from Driver. Enter the dates beside each signature.
Have the notary complete the first block
The notary adds the day and year, state, county (or City of St. Louis), commission expiration, signature, typed or printed name and seal or stamp.
Sign for the party receiving payment
The party receiving payment signs and dates the acceptance declaration. A second signature line is provided on the form.
Have the notary complete the second block
A notary swears the receiving side's signatures and completes the same notary details.
Review and download the completed PDF
Check names, dates and amounts against the agreement. Download or print the completed PDF from FillingPDF, then collect the signatures and notarizations and mail it as described under How to submit.
How to submit 1210
Form 1210 is returned by mail to the Missouri Department of Revenue, Driver License Bureau. The form also lists a phone number, fax number and e-mail address for questions.
- By mail: Driver License Bureau, P.O. Box 200, Jefferson City, MO 65105-0200. Send the completed form with the notary sections filled in and every required signature.
- Questions: phone (573) 751-7195; fax (573) 526-7365; e-mail [email protected]. The form lists these as contact details. Ask the Bureau before sending the form by fax or e-mail, since the form directs you to mail it.
- More information: the form refers to dor.mo.gov/drivers/.
FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Submitting the form without the notary sections completed; both the paying side and the receiving side have a Notary Required block.
- Signing before meeting the notary, when the block reads "Subscribed and sworn before me" and the notary completes the state, county and commission details.
- Leaving off the owner's signature, driver license number or date of birth when the owner is different from the driver.
- Omitting the signature of the party receiving payment, who must sign to accept the agreement.
- Writing dates in a different order than the MM/DD/YYYY pattern printed in the date boxes.
- Mailing the form somewhere other than Driver License Bureau, P.O. Box 200, Jefferson City, MO 65105-0200.
- Using Form 4338 or Form 5708 for an accident damage settlement; those are separate tax-related installment forms.
- Ignoring the default warning: the form states that operating and registration privileges will be suspended on notice of default.
Frequently asked questions
What is Form 1210, Installment Agreement, in Missouri?
Form 1210 is the Missouri Department of Revenue form that records a payment plan for a claim for damages and/or personal injuries from an accident. It lists the total owed, monthly payment, first and final payment dates, and carries sworn, notarized signatures from both sides.
Is Form 1210 the same as a tax installment agreement?
No. Form 1210 covers accident damage claims and is mailed to the Driver License Bureau. The Department's Forms page lists Form 4338, Tax Payment Installment Agreement Request, and Form 5708, Hardship Installment Agreement Application, as separate forms.
Does Form 1210 have to be notarized?
Yes. Both the section for the party agreeing to pay and the section for the party receiving payment are marked Notary Required. Each includes a "Subscribed and sworn before me" block with the notary's signature, name, county, commission expiration and seal.
Who signs Form 1210?
The driver signs as the party agreeing to pay, and the owner also signs if different from the driver. The party receiving payment signs to accept the agreement. Each declares under penalties of perjury that the information is true, complete and correct.
Where do I mail Form 1210?
Mail it to Driver License Bureau, P.O. Box 200, Jefferson City, MO 65105-0200. For questions, the form lists (573) 751-7195, fax (573) 526-7365 and [email protected].
What happens if I default on the agreement?
The form states that, under the Missouri Financial Responsibility Law, upon notice of default by the party or parties agreeing to make payment, the operating and registration privileges will be suspended.
Can I fill out Form 1210 online?
You can complete the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not file the form; you still need the notarized signatures and must mail the form to the Driver License Bureau.
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