MISSOURI DEPARTMENT OF REVENUE MOTOR VEHICLE BUREAU
P.O. BOX 3111
JEFFERSON CITY, MO 65109
TITLE ASSIGNMENT CORRECTION FORM
The Missouri Department of Revenue certifies that the record attached hereto is an exact duplicate of the original title/certificate of ownership lawfully filed or deposited with the Department pursuant to Chapter 301 RSMo for the unit listed below:
Year __ __ __ __ Make _______________________________________
Vehicle Identification Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
The attached document contains incomplete information. Please record the information listed below in the assignment area of this form. Make sure this form is signed and dated and then return to the Department of Revenue at the above address.
Purchaser(s) Name ____________________________________________________________________
Purchaser(s) Address ___________________________________________________________________
Odometer reading (No Tenths) at the time of purchase* __________________________________________
Signature of all Purchaser(s) ______________________________________ |
Date _________________________ |
Signature of all Seller(s) _________________________________________ |
Date _________________________ |
Sale Price ___________________________________________
*Sellers signature required when mileage is needed at the time of purchase.
Date of Sale ________________________
ACKNOWLEDGEMENT - SIGNATURE REQUIRED
I hereby declare under penalties of perjury, that I have completed the missing information on the form or had the seller complete the information as required by law. By signing below, I certify that the information listed is true, accurate, and complete to the best of my knowledge and belief.
BUSINESS NAME (PRINT COMPLETE NAME) ___________________________________________________________________________________
APPLICANT/BUYER OR AUTHORIZED AGENT’S PRINTED NAME AND POSITION _____________________________________________
APPLICANT/BUYER OR AUTHORIZED AGENT’S SIGNATURE ______________________________ |
DATE __________________________ |
SELLER’S PRINTED NAME _______________________________________________________________________ |
SELLER’S SIGNATURE ______________________________________________________ |
DATE __________________________ |