MISSOURI DEPARTMENT OF REVENUE MOTOR VEHICLE BUREAU
REQUEST FOR RECEIPT OF TITLE AND/OR REGISTRATION
THIS RECEIPT IS FOR PROOF OF PAYMENT ONLY. TO APPLY FOR A DUPLICATE TITLE,
PLEASE SEE FORM DOR-108, APPLICATION FOR MISSOURI TITLE AND LICENSE .
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TITLE RECEIPT (SHOWING TAX PAID)
REGISTRATION RECEIPT
(SHOWING PURCHASE OF LICENSE)
REASON REQUIRED: |
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VALIDATION |
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OWNER’S LEGAL NAME |
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STREET ADDRESS, R.R. OR P.O. BOX |
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COUNTY |
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CITY |
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STATE |
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ZIP CODE |
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VEHICLE INFORMATION |
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YEAR |
MAKE |
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VEHICLE IDENTIFICATION NUMBER |
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KIND OF VEHICLE |
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LICENSE PLATE NUMBER |
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TITLE NUMBER |
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ANY FALSE STATEMENT IN THIS APPLICATION IS A VIOLATION OF THE LAW AND MAY BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH. FORM MUST BE COMPLETED IN FULL AND NOTARIZED.
I HEREBY MAKE APPLICATION FOR A TITLE/REGISTRATION RECEIPT. I CERTIFY THAT I AM THE OWNER OR JOINT OWNER OF THE VEHICLE DESCRIBED ABOVE.
SIGNATURE OF OWNER |
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NOTARY INFORMATION
STATE |
SUBSCRIBED AND SWORN BEFORE ME THIS |
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NOTARY PUBLIC NAME (TYPE OR PRINTED) |
NOTARY PUBLIC SIGNATURE |
MY COMMISSION |
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EXPIRES |
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NOTARY PUBLIC EMBOSSER SEAL |
COUNTY (OR CITY OF ST. LOUIS) |
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USE RUBBER STAMP IN CLEAR AREA BELOW. |
MO 860-0378 (3-2011) DISTRIBUTION: WHITE—OFFICE YELLOW—AUDIT PINK—CUSTOMER
INSTRUCTIONS TO APPLICANT
1.This receipt is for proof of payment only. To apply for a duplicate title, please see Form DOR-108, Application for Missouri Title and License.
2.Only the owner or the joint owner of a motor vehicle may apply for a title/registration receipt.
3.The application must be completed in full and signed before a notary public. It should be typewritten or printed legibly. (Print so that all copies are legible.)
4.Fees — The total fees for a title/registration receipt is $8.50 for each receipt made and a $3.50 processing fee.
NOTE: THE MISSOURI DEPARTMENT OF REVENUE MAY ELECTRONICALLY RESUBMIT CHECKS RETURNED FOR INSUFFICIENT OR UNCOLLECTED FUNDS.
5.When this application is completed, it must be mailed to the MISSOURI DEPARTMENT OF REVENUE, MOTOR VEHICLE BUREAU, POST OFFICE BOX 100, 301 W HIGH ST, JEFFERSON CITY MISSOURI 65105-0100 or taken to a contract office. If mailing the application to the Motor Vehicle Bureau, a check or money order (DO NOT SEND CASH) for the correct amount made payable to the Missouri Department of Revenue must accompany the application. If you have any questions, please call the Motor Vehicle Bureau at (573) 526-3669.
Our web site address is www.dor.mo.gov.
MO 860-0378 (3-2011) |
DOR-2519 (3-2011) |