DOR-108 Application for Missouri Title and License

1 FIRST LIEN STREET ADDRESS, OR BOX NUMBER STREET ADDRESS, OR BOX NUMBERCITY STATE ZIP CODE CITY STATE ZIP CODENET PRICE$OTHER CREDIT$IF NEW, LIST GVWR MILEAGE CODE VEHICLE TRADE-IN $YEAR MAKE VEHICLE IDENTIFICATION NUMBER (IF TYPING, DISREGARD BLOCK CONSTRAINTS) BODY STYLE REBATE $TRANS TYPE RENEWAL/TRANSFER PLATES TRANSFER PLATES NEW PLATES Title ONLYSUYEAR MAKE License NUMBER EXP. YEARVEHICLE IDENTIFICATION NUMBER Title NUMBER I CERTIFY UNDER PENALTY OF PERJURY THAT THE FACTS HEREIN ARE TRUE TO THE BEST OF MY KNOWLEDGE. FIRST LIENHOLDER AUTHORIZES SECOND LIEN BY SIGNING HERE: OFFICE VALIDATIONMISSOURI DEPARTMENT OF REVENUEAPPLICATION FOR Missouri Title AND License Title WITHIN THIRTY DAYS TO AVOID PENALTY DOR-108 (02-2012)ANY FALSE STATEMENT IN THIS Application IS A VIOLATION OF THE LAW AND MAY BE PUNISHED BY FINE OR IMPRISONMENT OR USE ONLY REJECT NUMBER Title AND NOTICE OF LIEN(No complete change of ownership) License PLATE NO BRAND CODEORIGINAL (1)DUPLICATE (2)NON-NEGOT.

2 (3)PRIOR SALVAGECORRECTED (5)MECHANIC LIEN (6)SALVAGE (9)DUP. SALVAGE (0)JUNK (A)DUP. JUNK (B) TRANSFER ON TENANTS DEATH (TOD) IN COMMONOWNERVEHICLELIEN/MAIL TOTRADE- - DUPLICATE Title ONLYCOLOR FUELKIND OF VEHICLEP - PASSENGER M - MOTORCYCLET - TRUCK C - TRICYCLED - TRAILER R - REC. VEHICLEB - BUS A - ATV G - GASD - DIESELE - ELECTRIC B - BEYOND LOCALL - LOCAL S - SHUTTLEF - FARM T - TRANSIT GVWR OVER 16,000 LBS YESGR. WT. OR SEATINGCAPACITY NEW USED (MSO) ( Title ) CYL. TAB NUMBER EXP. MO. EXP. Title NO. STATE ZONE TRADE-IN License TRANSFER OTHER CREDIT12 FEESSIGNATURE OF ONE OWNER REQUIREDFOR OFFICE USE ONLYIf this motor vehicle is registered at the time Application for Title is made, my signature shall certify that I have and will maintain, during the period of registration, financial responsibility with respect to each motor vehicle that I own, License , or operate on the streets or must present your insurance card or other acceptable proof of financial false affidavit is a crime under Section of Missouri DEALER NUMBER DEALERSHIP NAME CITY, STATE, ZIP CODE TELEPHONE NUMBER ( ) I CERTIFY UNDER PENALTY OF PERJURY THAT THE FACTS HEREIN ARE TRUE TO THE BEST OF MY KNOWLEDGE.

3 SIGNATURE OF DEALER OR REPRESENTATIVE TRADE-IN YES NODUPLICATE Title ONLY - COMPLETE REASON AND NOTARIZE. notary INFORMATION APPLIES TO APPLICANT S SIGNATURE. LOST STOLEN MUTILATED (ATTACH MUTILATED Title ) NEVER RECEIVED - LOST IN MAILNOTARY PUBLIC EMBOSSER OR BLACK STATE COUNTY (OR CITY OF ST. LOUIS)RUBBER STAMP SEAL SUBSCRIBED AND SWORN BEFORE ME, THIS DAY OF notary PUBLIC SIGNATURE MY COMMISSION EXPIRES notary PUBLIC NAME (TYPED OR PRINTED)FIRST LIEN SECOND LIEN/MAIL TO SECURITY AGREEMENT DATEFIRST LIEN SECURITY AGREEMENT DATE YES NOLIENHOLDER S PHONE NO. SECOND LIEN ( ) YES NOMAIL TO LIENHOLDER MAIL TO ALTERNATE ADDRESS BELOW. DO NOT USE IF SECOND LIEN OR SUBJECT TO FUTURE ADVANCES. STFA FHVUTWGT. OF PLATES FORM 2290 DIST. AMT.$SITE CODEMILEAGE DATESURRENDERED PLATE NUMBERSURRENDERED PLATE CREDITPROCESSED BY APPROVE REJECTDONATIONS $1 BLIND FUND $1 ORGAN FUND $10 WW II MEMORIAL FUNDTOD BENEFICIARIES, IF APPLICABLECOUNTY FLEET NUMBER L/R NUMBER IN CITY LIMITS OUTSIDE CITY TELEPHONE NUMBER LIMITS ( ) DLN OR FEIN NUMBER $ CHECK BOX IF PLATE DOES NOT EXPIRE (B)IF EXEMPT FROM STATE OR LOCAL TAXES, ENTER EXEMPTION CODE HERE.

4 OWNER S NAME - LAST, FIRST, MIDDLE (ONLY FIRST 50 POSITIONS WILL PRINT ON Title ) INCLUDING TODSTREET ADDRESS (MUST BE A PHYSICAL ADDRESS - CANNOT BE A PO BOX OR RURAL ROUTE)CITY STATE ZIP CODEE-MAILDATEL=LP - PROPANE N - NATURALO - OTHER PP INS FEIN SAFETY EMISSIONYEYEPURCHASE DATEPRICELICENSE FEE$RESERVATION FEE$ADDITIONAL HP/DR/DRX$TRANSFER FEE$FAILURE TO TRANS/RENEW$RENEWAL PENALTY$ Title PENALTY$FUND DONATIONS$ Title /QUICK FEE$STATE TAX$LOCAL TAX$SUBTOTAL$PROCESSING OR AGENT FEE$NOL PROCESSING FEE$TOTAL$