Transcription of Form 5005 - Application/Affidavit for Missouri ...
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Form 5005 - Application/Affidavit for Missouri ...
$10 REPO. TITLE $ PROCESSING FEE $5 QUICK FEE TAX EXEMPT (#13)TOTAL$TITLE APPLICANTANY FALSE STATEMENT IN THIS APPLICATION IS A VIOLATION OF THE LAW AND MAY BE PUNISHED BY FINE OR IMPRISONMENT OR VALIDATIONDEBTOR S TITLE NO. STATE CURRENT MILEAGE CODE REPOSSESSION DATE OF UNITYEAR MAKE UNIT IDENTIFICATION NUMBER (IF TYPING, DISREGARD BLOCK CONSTRAINTS) BODY STYLELIENHOLDER NAME STREET ADDRESS, OR BOX NUMBER CITY, STATE, ZIP CODEMISSOURI DEPARTMENT OF REVENUEMOTOR VEHICLE BUREAUPO BOX 2076, JEFFERSON CITY MO 65105-2076(573)
A completed, signed, and notarized APPLICATION/AFFIDAVIT FOR MISSOURI REPOSSESSION TITLE (DOR-5005). A title fee of $10 and a $6.00 processing fee must be submitted. An additional $5 must also be submitted if a quick title
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