License Fee Waiver for Veterans and Spouses | Missouri Department of Insurance

First

Last

Phone Number

e.g., (573-555-1212)

License#

(if applicable)

Email

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Business Name where license will be used

(if applicable)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

License Type of Fee Requesting to be Waived

Application Type

I certify that I qualify for a fee waiver as a member of a “Military Family” as that term is defined in § 324.015.1(4). Specifically, I certify that

I am an active duty service member

I am the spouse of an active duty service member

I am an honorably discharged veteran

I am the spouse of an honorably discharged veteran

I am the surviving spouse of a decesased service member and have not remarried

(check all that apply)

I am requesting a fee waiver per the provisions of 324.015 RSMo, I have not received a fee waiver from this agency before, and I certify under penalty of perjury that all information is true and accurate to the best of my knowledge and ability.

Agree