Fillable Printable Form 184 - Application For Motor Vehicle License
Fillable Printable Form 184 - Application For Motor Vehicle License
Form 184 - Application For Motor Vehicle License
Vehicle License Is Being Transferred From
Year Make Title Number Horsepower
Vehicle Identification Number
Form
184
Missouri Department of Revenue
Application for Motor Vehicle License
Form 184 (Revised 11-2013)
Subscribed and sworn before me, this
day of year
State 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
__ __ / __ __ / __ __ __ __
Office Validation or Remarks
Owner’s Name - Last, First, Middle Telephone Number E-mail Address
Street, Rural Route, or P.O. Box City State Zip Code County
Mail To Address - If different than Owner’s Address
Street, Rural Route, or P.O. Box City State Zip Code
(__ __ __) __ __ __-__ __ __ __
Address
Information
MO
Registration
Process
Registration Period r 1-year r 2-year
Select One r J - New or Renew & Transfer r K - Renewal r M - Transfer r L - Change Weight or Zone
r S - Replaced from Stock Only - Notary Required r Z - Special r X - Data Correction r V - Reinstatement
License Plate or ATV Decal Number Tab Number Expiration Month Expiration Year
__ __ __ __ __ __
Notary
Information
r Vehicle out of state (Not ary no t req uired) - vehicle described above 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 safety
inspection station within ten (10) days after entering the state by me or my agent.
r Non-use (Notary required) - the motor vehicle described above has not been operated on
public roads or the highways of Missouri by me or my agent during the period of
__________________________________ to __________________________________.
I hereby certify that the statements herein are true to the best of my knowledge. I also 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 highways. Any false affidavit
is a crime under Section 575.050 of Missouri law. You must present your insurance card (a
copy is acceptable) or other acceptable proof of financial responsibility.
Signature of Owner
___________________________________________________________
Driver License Number or Federal Employer Identification Number______________________
Signature and Certification
Title Number Body Style Fuel
Odometer Reading from Inspection Purchase Date (MM/DD/YYYY) Passenger HP
Zone
Year Make Vehicle Identification Number (VIN)
__ __ / __ __ / __ __ __ __
Kind of Vehicle
(Choose One)
P - Passenger T - Truck D - Trailer B - Bus
M - Motorcycle C - Tricycle R - Rec. Vehicle A - ATV
Truck and
Bus
Gross Weight or Seat
Vehicle
Information
__ __ __ __
| | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | |
Renewal, Transfer or Replace
Registration Information
License Plate Number Current Tab # Exp. Mo. Exp. Year Zone Gr. wt/seat Horsepower
Reason for Replacement
r r r r r
(Notary Required)
Lost Stolen Mutilated Destroyed Never Received
__ __ __ __
Surrendered Surrendered Plate Number
r One Plate r Two Plates
License $
Reservation $
Additional HP $
Transfer $
Fail to Transfer or Renew $
Replacement(s) $
Renewal Penalty $
Reinstatement $
Subtotal $
Processing or Agent $
Total $
Fees
Y E
r PP r FHVUT rr INS
rr Safety rr EMISS
Y E
Y E
Office
Use Only
r $1 Blind r $1 Organ
WWI Memorial Trust Fund
r $1 r $10 r Other $
Surrendered Plate Credit $
Donations
and Credits
Reset Form
Print Form
0.00
0.00
r Application for License completed and signed by the applicant.
r Appropriate registration and processing fees posted at
http://dor.mo.gov/motorv/fees.php#regisfees.
r Proof of ownership (a copy of the registration receipt, title, or
copy of title). If no title number, record office number and title
application date in appropriate box.
r Vehicle safety inspection (if required) not more than 60 days
old. New (not previously titled) motor vehicles.
r Vehicle emissions inspection (if required) not more than 60 days
old must be submitted by residents in the city of St. Louis and
the following counties: Franklin, Jefferson, St. Charles, and St.
Louis. Applies only to certain passenger vehicles and trucks
with a manufacturer’s gross weight rating of 8,500 pounds or less.
r Paid personal property tax receipt or a statement of non-
assessment from the county (or city of St. Louis) in which you
resided on January 1st of the previous year. The property tax
receipt or statement of non-assessment must be in the owner’s
name. One receipt must be presented for the previous year to
renew a one-year registration and two receipts must be
presented for the last two years to renew a two-year registration.
r Insurance card or other acceptable proof of financial responsibility.
Note: Vehicle safety inspection, vehicle emissions inspection, paid
personal property tax receipt or statement of non-assessment, and
insurance card are not required when applying for an ATV decal.
Note: See http://dor.mo.gov/motorv/help.php for vehicles that are
exempt from safety and or emissions inspection.
Required Documents
Checks or money orders may be accepted as payment. Make the check or money order payable to: Missouri Department of Revenue. The
check must be preprinted with the check writer’s name and address, bank code, and account number. It must also include the following
information regarding the check writer:
1. Driver license or non-driver license number;
2. Date of birth; and
3. Daytime phone number.
Do not send cash when applying by mail.
The Missouri Department of Revenue may electronically resubmit checks returned for insufficient or uncollected funds. Other restrictions may
also apply.
Payment Methods
Please follow the order of the instructions provided below, beginning
with Type of Registration when completing the application. If there
is no instruction for a particular field, simply provide the information
requested, such as Owner’s Name and Address. Please write legibly.
Instructions:
1. Registration Process — Check the appropriate block.
2. Year, Make, Vehicle Identification Number, Title Number, and
Body Style — Record in the designated areas. If you hand write
the application, record only one character in each block within the
Vehicle Identification Number.
3. Fuel — Enter the appropriate code.
4. Kind of Vehicle (KOV), Horsepower (HP), Zone, and Gross
Weight or Seating Capacity — Record the correct code.
For passenger vehicles provide the taxable horsepower. For
trucks, enter the appropriate zone of operation and the truck’s
licensed gross weight or seating capacity.
5. Mileage — Record the odometer reading from the vehicle
inspection, when applicable.
6. Purchase date — Record the date vehicle was purchased.
7. License Plate Number — Record current license plate on vehicle,
when applicable.
8. Expiration Month and Year — Record the month and year that
the current license plates expire.
9
. License Transfer or Replace Information — Year, Make, Vehicle
Identification Number, Title Number, Taxable Horsepower —
Record the information from the previous vehicle in the
designated areas.
10. $1 Blind Fund, $1 Organ Fund, and WWI Memorial Trust Fund —
Check appropriate block(s) if you wish to donate to the fund(s).
11. Signature — One owner must sign the application for license.
All incorrect or incomplete applications will be rejected.
Submit the required items and fees to your local contract office or
mail to: Motor Vehicle Bureau, P.O. Box 2046, Jefferson City, MO
65105-2046.
Direct inquiries to (573) 526-3669 or visit our website at:
http://dor.mo.gov/.
Remember to sign the application and submit proof of ownership,
appropriate inspection(s), paid personal property tax receipt(s), proof
of insurance, registration fees, and applicable processing fees.
Completing the License Application
A $5 penalty fee will be assessed for failing to renew a license plate within the month of expiration. (Does not apply to trailers and trucks
licensed in excess of 12,000 lbs.) An $8.50 penalty fee will be assessed for failing to transfer or renew multi-year license plates.
Penalties
Form 184 (Revised 11-2013)
Mail to: Motor Vehicle Bureau
P.O. Box 2046 Phone: (573) 526-3669
Visit http://dor.mo.gov/motorv/licplate.php
for additional information.
