Fillable Printable Form 5175 - Missouri Department Of Revenue
Fillable Printable Form 5175 - Missouri Department Of Revenue
Form 5175 - Missouri Department Of Revenue
Form
5175
Missouri Department of Revenue
Request for Additional Plates for Official State Vehicles
Requester
Agency or University Name
Agency Telephone Number
Signature of Agency Head or DesigneeDate (MM/DD/YYYY)
Form 5175 (Revised 07-2017)
Mail to:Motor Vehicle Bureau
301 West High Street, Room 370 Phone: (573) 751-5209
P.O. Box 2076 Fax: (573) 751-4789
Jefferson City, MO 65105-2076 E-mail:[email protected]
Visit //dor.mo.gov/motorv/
for additional information.
4. Safety or emissions inspection, if applicable.
Contact Name
Contact Person’s E-mail Address
Agency Fax Number
Plate Requested
New VehicleNew TrailerNew MotorcycleReplacement Vehicle or Trailer
Number of Plates Requested
This form is not required when you replace a vehicle or trailer within 90 days and use the plate assigned from the prior vehicle or trailer.
Printed Name
Central Office Only
Office of Administration
Signature of Fleet ManagerDate (MM/DD/YYYY)Printed Name
Department of Revenue
Tracking Number
Date (MM/DD/YYYY)
Plate Number(s) Ordered
Instructions
Submit this completed form by clicking on the button or mail to the address below. Upon completion, the Department will return the form
to you with a tracking number and the plate number(s) ordered. Please allow 21 days for new plates to arrive.
The following documents must be included with this form when registering the vehicle(s):
1. Application for Missouri Title and License (Form 108);
2. Application for Motor Vehicle License (Form 184);
3. Appropriate ownership documents; and
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