Fillable Printable Form 4576 - Abandoned Property Affidavit

Form 4576 - Abandoned Property Affidavit

Form

4576

Missouri Department of Revenue

Abandoned Property Affidavit

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

__ __ /__ __ /__ __ __ __

Notary Information

Section 304.156, RSMo, provides that thirty (30) days after a notification form has been mailed to the abandoned property owner

and lienholder, if applicable, and the property is unredeemed and no satisfactory arrangement has been made with the lienholder in

possession for continued storage, and the owner or lienholder, if applicable, has not requested a hearing as provided, the lienholder

in possession may apply to the Director of Revenue for an original title, salvage certificate of title designated with the words “Salvage

or Abandoned Property” or junking certificate based on the condition of the abandoned property. This affidavit must be included with

the application for title. See checklist on reverse for other requirements.

Abandoned Property Towed

Year Make Model Vehicle, Vessel, Outboard Motor Identification Number

Owner Lienholder

Street Address Street Address

City State Zip City State Zip

On __ __ / __ __ / __ __ __ __

, I towed the above mentioned property. I have been in possession of the abandoned property

for at least 30 days and the owner of the abandoned property or lienholder have not made arrangements for payment of towing

and storage charges. I have not been notified of any application for hearing as provided in Section 304.156, RSMo.

If notice to the owner and lienholder of the abandoned property has been returned “Not Forwardable” or “Addressee Unknown,”

my signature on this affidavit certifies that a physical search of the abandoned property disclosed no other evidence of

ownership and that a good faith effort has been performed to establish the prior state of registration and title. The following

was searched, if applicable:

1. The abandoned property for any type of license plates, license plate record, temporary permit, inspection sticker, decal,

or other evidence which may indicate a possible registration and title in another state;

2. The law enforcement report for a license plate number or registration number if the abandoned property was towed at

the request of a law enforcement agency;

3. The tow ticket or report of the tow truck operator to see if a license plate was on the abandoned property at the

beginning of the tow, if a private tow; and

4. The law enforcement report to see if an out-of-state address is indicated on the driver license information if there is no

address of the owner on the impound report.

Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.

Towing Company Name Signature of Tower Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __

Signature

Visit

http://dor.mo.gov/forms/Abandoned_Vehicle_Manual.pdf

for additional information.

Form 4576 (Revised 07-2017)

This form must be attached to your motor vehicle registration application.

Motor Vehicle Bureau Phone:

301 West High Street – Room 370 (573) 526-3669

Jefferson City, MO 65101

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Instructions for Titling Abandoned Property

Please contact the Motor Vehicle Bureau with any questions regarding titling abandoned property. Abandoned property includes

motor vehicles, trailers, all-terrain vehicles, outboard motors, and vessels.

Titling requirements for units towed from public or private property with authorization from law enforcement or a governmental

agency:

1. Application for title, properly completed in the tower’s company name. The title type must be marked “Original”, “Salvage”,

or “Junking Certificate” (No title fee is required);

2. Abandoned Property Affidavit (Form 4576) properly completed, signed by the tower and notarized by a notary public;

3. A copy of the Vehicle Owner and Lienholder Notification (Form 4577) issued to any owner and lienholder of record.

This must be sent by certified mail;

4. A copy of the certified mail receipts at least 30 days old, indicating the owner and lienholder of record, if applicable, have

been sent the above notice;

5. A copy of the online record search or notice the Motor Vehicle Bureau issued to the tower informing the tower of the latest

owner or lienholder of record;

6. A completed and signed Vehicle Examination Certificate (Form 551), if applying for an “Original” title; and

7. Crime Inquiry and Inspection Report completed by authorized law enforcement.

Titling requirements for units towed from private property without authorization from law en force ment or a governmental agency:

1. Items 1 through 6 above; and

2. Abandoned Property Report (Form 4669) completed by the property owner, towing company, and law enforcement.

Form 4576 (Revised 07-2017)