Fillable Printable Form 5005 - Missouri Department Of Revenue
Fillable Printable Form 5005 - Missouri Department Of Revenue
Form 5005 - Missouri Department Of Revenue
$10 REPO. TITLE
$2.50 PROCESSING
FEE
$5 QUICK
FEE
TAX EXEMPT (#13)
TOTAL
$
TITLE APPLICANT
ANY FALSE STATEMENT IN THIS APPLICATION IS A VIOLATION OF THE LAW AND MAY BE
PUNISHED BY FINE OR IMPRISONMENT OR BOTH.
OFFICE VALIDATION
DEBTOR’S TITLE NO. STATE CURRENT MILEAGE CODE REPOSSESSION DATE
OF UNIT
YEAR MAKE UNIT IDENTIFICATION NUMBER (IF TYPING, DISREGARD BLOCK CONSTRAINTS) BODY STYLE
LIENHOLDER NAME
STREET ADDRESS, R.R. OR P.O. BOX NUMBER
CITY, STATE, ZIP CODE
MISSOURI DEPARTMENT OF REVENUE
MOTOR VEHICLE BUREAU
PO BOX 2076, JEFFERSON CITY MO 65105-2076
(573) 526-3669 www.dor.mo.gov/mvdl
APPLICATION/AFFIDAVIT FOR MISSOURI
REPOSSESSION TITLE
Form 5005 (Revised 08-2017)
STAPLE
HERE
BRAND CODE
UNIT DESCRIPTION
DEBTOR
LOC. OF
UNIT
MAIL TO
LOCATION
SIGNATURE
FUEL
KIND OF VEHICLE
P - PASSENGER M - MOTORCYCLE
T - TRUCK C - TRICYCLE
D - TRAILER/MANF. HOME R - REC. VEHICLE
B - BUS A - ATV
®
®
TYPE ALL APPLICATIONS - QUESTIONS SHOULD
BE REFERRED TO (573) 526-3669.
DOR USE ONLY-REJECT NUMBER
FORM
5005
(REV. 08-2017)
IF UNIT WAS TOWED, RECORD THE NAME OF THE LAW
ENFORCEMENT AGENCY THE VEHICLE WAS REPORTED TO:
TELEPHONE NUMBER
( )
KIND OF VEHICLE (K.O.V.) CYLINDER HORSEPOWER
REPO. TITLE FEES
DEBTOR’S NAME
STREET ADDRESS, R.R., OR P.O. BOX NUMBER CITY, STATE, ZIP CODE
STREET OR PHYSICAL ADDRESS OF THE UNIT LOCATION CITY, STATE, ZIP CODE
MAIL TITLE TO ADDRESS BELOW IF DIFFERENT FROM APPLICANT’S ADDRESS
NAME
STREET ADDRESS, R.R., OR P.O. BOX NUMBER CITY, STATE, ZIP CODE
MODEL NUMBER
COLOR LENGTH MATERIAL BOAT TYPE ENGINE DRIVE TYPE TYPE OF PROPULSION
IF MISSOURI TITLE FILL IN FIRST
FOUR LETTERS OF PREVIOUS
OWNER’S LAST NAME
®
FT. IN.
BOAT / VESSEL LICENSE ID NUMBER TYPE OF USE
MO
NOTARIZATION
REQUIRED
BOAT/VESSEL
OUTBOARD
MOTOR
TRAILER
NOTARY PUBLIC EMBOSSER STATE
COUNTY (OR CITY OF ST. LOUIS)
OR BLACK
RUBBER STAMP SEAL
SUBSCRIBED AND SWORN BEFORE ME, THIS
DAY OF
NOTARY PUBLIC SIGNATURE MY COMMISSION EXPIRES
NOTARY PUBLIC NAME (TYPED OR PRINTED)
I certify under penalties of perjury that the debtor has defaulted in payment of the debt on the unit listed above and the unit has been repossessed either by legal
process or in accordance with the terms of the security contract. I have written consent from all owners and/or lienholders of record to repossess this unit or I have
provided all owners/lienholders with a 10-day written notice by first class mail or as outlined in the Uniform Commercial Code, of the repossession and that an
application for repossessed title will be made and the notice has now expired. If the unit being
repossessed is a manufactured home, I further affirm that as the holder of such manufactured
home, I have paid all rent accrued to the owner of any real property where such rent is
obligated to be paid pursuant to the provisions of Section 700.529, RSMo, if applicable.
SIGNATURE OF LIENHOLDER’S REPRESENTATIVE (REQUIRED)
X
BOAT/VESSEL/
OUTBOARD MOTOR
MOTOR
VEHICLE
MANUFACTURED
HOME
G - GAS L - LP - PROPANE
D - DIESEL E - ELECTRIC
N - NAT. GAS V - PLUG-IN HYBRID
O - OTHER ELEC. VEHICLE
A completed, signed, and notarized APPLICATION/AFFIDAVIT FOR MISSOURI REPOSSESSION TITLE (DOR-5005).
A title fee of $10 and a $2.50 processing fee must be submitted. An additional $5 must also be submitted if a quick title
is requested.
A validated copy of the Notice of Lien (DOR-4809 or DOR-108) receipt or the actual title must accompany the
repossession application reflecting the lienholder.
Repossession titles cannot be issued on documented vessels.
REQUIRED DOCUMENTS
Check or money order 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 UNCOL LECTED FUNDS. Other restrictions may also apply.
PAYMENT METHODS
To apply for repossession title for a motor vehicle, trailer, all terrain vehicle, manufactured home, boat/vessel, or outboard
motor you must submit the required documents to your local Motor Vehicle and Driver Licensing Contract Office or mail
to the Missouri Department of Revenue, Motor Vehicle Bureau, P.O. Box 2076, Jefferson City, MO 65105-2076.
COMPLETING THIS APPLICATION
BOAT/VESSEL CODES
Form 5005 (Revised 08-2017)
TYPE OF USE
Charter Fishing
Commercial Fishing
Commercial Passenger Carrying
Dealer or Manufacturer Demonstration
Other Commercial Operation
Pleasure
Rent or Lease
COLOR CODE
Beige BGE
Black BLK
Blue BLU
Brown BRO
Bronze BRZ
Chrome (Stainless Steel) COM
Copper CPR
Cream (Ivory) CRM
Dark Blue DBL
Dark Green DGR
Gold GLD
Green GRN
Gray GRY
Lavender
LAV
Light Blue LBL
Light Green LGR
Maroon MAR
Orange ORG
Purple PLE
Pink PNK
Red RED
Silver (Aluminum) SIL
Tan TAN
Turquoise TRQ
White WHI
Yellow YEL
TYPE OF MATERIAL CODE
Aluminum ALUM
Concrete CONCR
Fiberglass FGLAS
Hypal HYPAL
Kevla - Type of Fiberglass KEVLA
Other OTHER
Plastic PLAS
Rubber/Vinyl/Canvas RUBBR
Steel STEEL
Wood WOOD
BOAT TYPE CODE
Airboat AIR
Amphibious AMP
Auxiliary Sail AUX
Barge BAR
Bass Boat BAS
Cabin Motorboat CAB
Canoe CAN
Commercial COM
Cruiser CRU
Day Cruiser DAY
Deck Boat DEC
Drag or Performance Boat DRG
Houseboat HSE
Hovercraft HOV
Hydrofoil HYD
Hydroplane HRO
Inatable Boat RAF
Jet Ski JET
Ofcial OFF
Open Motorboat OPE
Other OTH
Paddlecraft PAD
Personal Watercraft PER
Pontoon PON
Rowboat ROW
Runabout RUN
Sail Only SAL
Submarine SUB
Surf Jet SUR
Utility UTL
Wet Bike WET
Yacht YAT
ENGINE DRIVE TYPE CODE
Inboard INB
Outboard OUT
Pod Drive POD
Sterndrive STE
Other OTH
TYPE OF PROPULSION CODE
Air Thrust AIR
Manual MAN
Other OTH
Propeller PRO
Sail SAIL
Water Jet WAT
