Transcription of Form 5005 - Missouri
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Example: bankruptcy
Form 5005 - 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) 526-3669 FOR MISSOURIREPOSSESSION TITLE Form 5005 (Revised 08-2019)STAPLEHEREBRAND CODEUNIT DESCRIPTIONDEBTORLOC.
type all applications - questions should be referred to (573) 526-3669. dor use only-reject number form 5005 (rev. 08-2019) if unit was towed, record the name of the law enforcement agency the vehicle was reported to: telephone number ( ) kind of vehicle (k.o.v.)kind of vehicle cylinder horsepower repo. title fees debtor’s name
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