MO 860-0301 (10-00) DOR-768 (5-00)
WARNING: ÒANY FALSE STATEMENT IN THIS
AFFIDAVIT IS A VIOLATION OF LAW, AND MAY BE
PUNISHED BY FINE OR IMPRISONMENT, OR BOTH
(301.420).Ó QUESTIONS SHOULD BE REFERRED TO
COMPLETE INFORMATION AS REQUIRED
I, the undersigned, do hereby certify that . . . .
1. DUPLICATE/REPLACEMENT NEEDED Duplicate Title Replacement Plate Replacement Tab . . . . the
indicated item was lost, stolen or mutilated under the following circumstances. If document later found it will
be returned to the Department of Revenue. If a mutilated item, it must be submitted with this request. If a plate was lost,
please specify the law enforcement agency notified.
2. NON-USE . . . . the motor vehicle described on the attached application has not been operated on public roads or the
highways of Missouri by me or my agent during the
3. GIFT . . . . I am giving this motor vehicle to
and there is no money or other valuable consideration involved in the transaction.
4. VEHICLE OUT OF STATE . . . . vehicle described below has not been within the State of Missouri for the sixty (60)
day period immediately preceding the date of this application for registration but will be submitted for inspection at
an official inspection station within ten (10) days after entering the state by me or my agent.
5. I hereby certify that I am a trustee named in the
and am authorized to act on behalf of the trust agreement and transfer ownership of the vehicle referenced.
6. NAME CHANGE . . . . I hereby certify that my name has been changed from ______________________________________
due to marriage or divorce and that I am one and the same person.
7. Other . . . .
OWNER (TYPE OR PRINT) YEAR MAKE
SIGNATURE OF OWNER CURRENT MILEAGE
VEHICLE IDENTIFICATION NUMBER ORIG. TITLE NO. CURRENT LIC. NO.
NOTARY PUBLIC - (ONLY REQUIRED ON ITEM(S) 1 AND 2)
NOTARY PUBLIC EMBOSSER OR STATE OF COUNTY (OR CITY OF ST. LOUIS)
BLACK INK RUBBER STAMP SEAL
SUBSCRIBED AND SWORN BEFORE ME, THIS
USE RUBBER STAMP IN CLEAR AREA BELOW.
NOTARY PUBLIC SIGNATURE MY COMMISSION
NOTARY PUBLIC NAME (TYPED OR PRINTED)