Form 1062 - Affidavit for Mechanic Lien Title

1 Owner InformationYear Make Vehicle or Manufacturer s Identification Number Amount of Repair or Storage Titled Owner s Name Number of Months Payment Overdue (minimum of 45 days)Owner s Address City State ZIP Code I certify that the motor vehicle, trailer, all-terrain vehicle, manufactured home, vessel, or outboard motor listed below is in my possession and that the owner of said unit has defaulted in payment. The total amount of repair and storage that is noted below has not been paid as evidenced by the attached work order or storage bill. The owner and lienholder listed below were notified of this debt by certified mail on the date noted. Copies of the notification letter(s) and the certified mail card(s) have been submitted with this Affidavit . Neither the owner nor the lienholder has paid, or made satisfactory arrangements for payment of, storage or service towing charges within 30 days since notification of my intent to Title the unit.

2 See requirements on __ __ __All Lienholders InformationName of Vehicle Owner s LienholderStreet Address City State ZIP CodeName of Mechanic or GarageStreet Address City State ZIP CodeDate Owner Notified by Certified Mail (MM/DD/YYYY) Signature of Applicant__ __ /__ __/__ __ __ __Notary InformationSubscribed and sworn before me, this day of yearState County (or City of St. Louis) My Commission Expires (MM/DD/YYYY)Notary Public Signature Notary Public Name (Typed or Printed) Embosser or black ink rubber stamp seal__ __ /__ __ /__ __ __ __Form1062 Affidavit for Mechanic Lien TitleMail to: Motor Vehicle Bureau Box 2076 Jefferson City, MO 65102-2076 Phone: (573) 526-3669 Fax: (573) 751-5209E-mail: 1062 (Revised 02-2022)Ever served on active duty in the United States Armed Forces?

3 If yes, visit to see the services and benefits we offer to all eligible military individuals. A list of all state agency resources and benefits can be found at Lien TitleIn order to apply for a Mechanic lien Title for a motor vehicle, trailer, all-terrain vehicle, manufactured home, vessel, or outboard motor, you must submit the following:1. Application for Missouri Title and License (Form 108) (for motor vehicles, trailers, all-terrain vehicles, and manufactured homes) or Application for Missouri Boat/Vessel or Outboard Motor Title and Registration (Form 93) (for vessels or outboard motors). For type of Title , record Mechanic lien ; For a motor vehicle in which the model year is 2011 or newer and the motor vehicle is less than 20 years old, the odometer reading must be reported on the Title application.

4 If the true mileage is unknown, a statement containing all known facts regarding the true mileage is Notarized Mechanic Lien Affidavit (Form 1062);3. Signed work order, storage agreement, or tow agreement; 4. A statement showing the outstanding balance for all labor, services, skills, materials, or storage costs accumulated up to the date of application for Title ;5. A copy of the 30-day notice of Owner(s) and Lienholder(s) Regarding intent to File for Mechanic Lien Title (Form 5835) or similar notice sent by certified mail and evidence the notices were sent;6. Evidence the notices were sent include the tracking documentation from an established national postal or parcel delivery service (including, but not limited to, the US Post Office, Federal Express, or United Parcel Service etc.)

5 If the certified notice is returned to sender, submit a copy of the envelope stamped return to sender ;7. If the vehicle is not currently titled in Missouri; and Copy of the out-of-state Title search indicating the owner(s) and lienholder(s) of record; and A vehicle identification number and odometer reading inspection completed by an authorized Missouri inspection station or an Application for Vehicle/Trailer Identification Number Plate or Verification (Form 5062).8. $ Title fee and $ processing : License office notary service fee - $ : If the application for a Mechanic lien Title is submitted prior to the expiration of the 30-day notice , the application will be held until the 30-day notification period has 1062 (Revised 02-2022)