Fillable Printable Form 5062 - Missouri Department Of Revenue
Fillable Printable Form 5062 - Missouri Department Of Revenue
![Form 5062 - Missouri Department Of Revenue](/resources/formfile/images/gov1028/form-5062-missouri-department-of-revenue-page1.png)
Form 5062 - Missouri Department Of Revenue
![](/resources/formfile/htmls/gov1028/form-5062-missouri-department-of-revenue/bg1.png)
MISSOURI DEPARTMENT OF REVENUE
MOTOR VEHICLE BUREAU
APPLICATION FOR VEHICLE/TRAILER IDENTIFICATION
NUMBER PLATE OR VERIFICATION
FORM
5062
(REV. 12-2015)
CONTROL NO.
SEE INSTRUCTIONS ON REVERSE
MOTOR VEHICLE/TRAILER/MANUFACTURED HOME
SECTION B — NOTARY PUBLIC
VALIDATION ONLY
REGISTERED OWNER (LAST, FIRST, MIDDLE) DEALER NUMBER COUNTY DAYTIME TELEPHONE NUMBER
STREET, RR, OR P.O. BOX NUMBER CITY STATE ZIP CODE
YEAR MAKE VEHICLE IDENTIFICATION NUMBER MISSOURI TITLE NUMBER LICENSE NUMBER
BODY STYLE MODEL COLOR CYLINDERS H.P. MILEAGE
COMPLETE THE INFORMATION BELOW IF APPLYING FOR A REPLACEMENT VIN — APPLICATION MUST ALSO BE NOTARIZED
LOSS OF VIN. PLATE REPORTED TO: DATE REASON REQUIRED
LOST STOLEN MUTILATED DESTROYED
I certify that the statements above are true and that I am the registered
owner of the above described unit(s). SIGNATURE
APPLICANT’S SIGNATURE
NOTARY PUBLIC EMBOSSER OR STATE COUNTY (OR CITY OF ST. LOUIS)
BLACK INK RUBBER STAMP SEAL
SUBSCRIBED AND SWORN BEFORE ME, THIS
DAY OF YEAR
USE RUBBER STAMP IN CLEAR AREA BELOW.
NOTARY PUBLIC SIGNATURE MY COMMISSION
EXPIRES
NOTARY PUBLIC NAME (TYPED OR PRINTED)
I certify that on __ __
/
__ __
/
__ __ __ __ I physically inspected the above described vehicle/trailer after the
applicant provided satisfactory proof of ownership and found the identification number(s) as recorded below.
I certify that on
__ __
/
__ __
/
__ __ __ __ I did affix the new/replacement VIN plate, control number ______________________________ issued by the
Department of Revenue to the above vehicle.
The outstanding VIN plate listed above has been surrendered and forwarded to the Missouri State Highway Patrol, Motor Vehicle Inspection Division.
PUBLIC VIN
POLICE VIN
The VIN plate listed below must be surrendered
at the time a new replacement number is issued.
_________________________________
LAW ENFORCEMENT AGENCY FILE NUMBER EXAMINING OFFICER’S SIGNATURE TELEPHONE NUMBER BADGE NO.
LAW ENFORCEMENT AGENCY LAW ENFORCEMENT OFFICER’S SIGNATURE BADGE NO.
APPLICANT COMPLETES
NOTARY COMPLETES
LAW ENFORCEMENT COMPLETES
INSTRUCTIONS:
Step 1: Applicant must complete and sign Section A.
Step 2:
If a replacement vehicle identification number (VIN) is required,
Section B must be notarized by a notary public.
Step 3:
Submit your motor vehicle/trailer and this form to authorized law
enforcement as designated on the reverse side of this form.
Step 4:
Submit the completed form to the Department of Revenue as noted
on the reverse side of this form.
PURPOSE OF INSPECTION: (Select one):
TITLE CORRECTION OR VEHICLE VIN VERIFICATION
NEW IDENTIFICATION NUMBER PLATE
REPLACEMENT IDENTIFICATION NUMBER PLATE
TRAILER WITH A SALVAGE TITLE
UNIT: (Select one):
MOTOR VEHICLE
MANUFACTURED TRAILER
HOMEMADE TRAILER (16 FEET OR MORE)
MANUFACTURED HOME BUILT PRIOR TO 1976
(REQUIRES INSPECTION FROM PUBLIC SERVICE COMMISSION)
SECTION A — APPLICANT
YEAR MAKE BODY STYLE MILEAGE CYLINDERS
REMARKS AND DISCREPANCIES NOTED
TO BE COMPLETED BY AUTHORIZED LAW ENFORCEMENT WHEN A DR NUMBER OR REPLACEMENT VIN PLATE IS AFFIXED.
REPLACEMENT VIN REQUIRED NEW VIN REQUIRED — IF A TRAILER: UNIT IS: HOMEMADE MORE THAN 16 FEET MANUFACTURED TRAILER
NO NEW/REPLACEMENT VIN REQUIRED TYPE OF TRAILER ________________________________________________ NO OF AXLES ________________ LENGTH ______________
Office Use Only — New ID:
CONDITION:
#
DAMAGED
#
RUNNING
#
REBUILT
#
MOTOR CHANGE
#
OTHER
____________________
SECTION C — FOR AUTHORIZED LAW ENFORCEMENT AGENCY USE ONLY — DO NOT WRITE BELOW THIS LINE
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)
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__ __ __ __ __
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)
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MO
MOTOR VEHICLES AND TRAILERS ONLY. NOT TO BE USED FOR MANUFACTURED HOMES.
Form 5062 (Revised 12-2015)
VIN TO BE REPLACED
DISTRIBUTION: WHITE — DEPARTMENT OF REVENUE; CANARY — INSPECTING LAW ENFORCEMENT AGENCY
SAMPLE
Not For Use or
Distribution
![](/resources/formfile/htmls/gov1028/form-5062-missouri-department-of-revenue/bg2.png)
INSTRUCTIONS TO APPLICANT — READ CAREFULLY
This form is to be used when a vehicle/trailer identification number (VIN) plate needs to be verified, issued, or replaced.
Any false statement in this application is a violation of the law and may be punished by fine or imprisonment or both.
1. Print or typewrite with black ink.
2. Before the application can be accepted by the Missouri Department of Revenue (department), an examination to determine the
true identity of the vehicle/trailer must be made only by the authorized law enforcement, the Missouri State Highway Patrol
(MSHP), a member of the St. Louis City or County Auto Theft Unit or the Missouri Public Service Commission (manufactured
homes only) as outlined below.
3. This application must be accompanied by the documents and fees outlined below. If the application is for a corrected title/
vehicle verification or for a new VIN plate for a homemade trailer, the application may be submitted to any Department of Revenue
contract office. If the application is for a new VIN plate for a motor vehicle or manufactured trailer, or for a replacement VIN for
any motor vehicle or trailer, the application must be mailed directly to Motor Vehicle Bureau, PO Box 2076, Jefferson City MO
65105-2076.
The original form must be submitted to the department. The copy will be retained by the inspecting agency.
DO NOT SEND CASH. 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.
THE MISSOURI DEPARTMENT OF REVENUE MAY ELECTRONICALLY RESUBMIT CHECKS RETURNED FOR INSUFFICIENT OR
UNCOLLECTED FUNDS. Other restrictions may also apply.
4. The identification number plate (excluding a new VIN plate for a homemade trailer) will be forwarded to the applicable agency
(as listed in paragraph above 2) for proper attachment to the unit. The agency will contact the owner for an appointment to attach
the plate to the unit.
WHO CAN COMPLETE THE INSPECTION PORTION OF THIS FORM?
Title Correction or Vehicle VIN Verification — Any authorized law enforcement — Missouri State Highway Patrol (MSHP), county
sheriff, police, etc. An additional inspection completed by an authorized officer of the MSHP or a member of the St. Louis City or
County Auto Theft Unit may be required. The inspection portion of this form is not required for a new or replacement VIN on a
manufactured home (complete section A and see list of required documents below).
New VIN for Trailer:
• Manufactured trailer — Any authorized officer of the MSHP or a member of the St. Louis City or County Auto Theft Unit.
• Homemade trailer 16 feet or more in length — County sheriff from applicant’s county or MSHP.
• Homemade trailer less than 16 feet in length — Do not use this form. The trailer must be inspected by an official safety inspection station
• Trailer with a Salvage Title — The form must be completed by an authorized officer of the Missouri State Highway Patrol or St. Louis
City or County Auto Theft Unit.
• Replacement VIN — Any authorized officer of the MSHP or a member of the St. Louis City or County Auto Theft Unit.
• New and Replacement VIN for Manufactured Home — Home must be manufactured prior to 1976 and can only be inspected by the
Missouri Public Service Commission.
WHAT DOCUMENTS AND FEES ARE REQUIRED?
Title Correction
• This completed form;
• Application for title;
• Certificate of title; and
• $11 (title and processing fee).
New VIN Plate for Trailer
• This completed form;
• Application for title;
• Certificate of title (unless homemade trailer over 16 feet being titled for the first time);
• $11.00 (title and processing fee);
• $10.00 (inspection fee), if applicable — not required if the county sheriff collected the fee (applies only to homemade trailers over 16 feet);
• $10.00 (VIN plate fee or replacement VIN plate fee and processing fee), if applicable; and
• State and local taxes and applicable title penalties if a change of ownership (does not apply to first time title of a homemade trailer).
Replacement VIN for any Motor Vehicle, Trailer, or Manufactured Home
• This completed form (for a new or replacement VIN on a manufactured home, the homeowner must complete section A of this form
only, sign and have their signature notarized);
• $10.00 (replacement VIN plate fee and processing fee); and
• Inspection documentation from the Missouri Public Service Commission.
If a change of ownership, the following must also be submitted:
• Properly assigned title;
• Title application;
• $11.00 (title and processing fee); and
• State and local taxes and applicable title penalties if a change of ownership.
Form 5062 (Revised 12-2015)
SAMPLE
Not For Use or
Distribution