Form 5429 Temporary License Plate Application

Missouri Department of Revenue

Temporary License Plate Application

Form

5429

Certification and Signature

Form 5429 (Revised 01-2015)

Mail To: Motor Vehicle Bureau Phone: (573) 526-3669

P.O. Box 2076 E-mail: [email protected]

Jefferson City, MO 65105-2076

Applicant Information

Printed Name Date (MM/DD/YYYY)

Signature

Any false statement in this application is a violation of the law and may be

punished by fine or imprisonment or both. I certify that I am the owner of the above

referenced motor vehicle. I understand that the temporary license plate only

authorizes the use of the vehicle when the actual matching plate is valid and

affixed to the vehicle as prescribed by law. Furthermore, I understand that the

temporary license plate is to be placed in the interior of the vehicle’s rear window

sufficiently as to not obstruct the driver’s view and so that the plate configuration is

clearly visible when the actual rear license plate cannot be viewed.

County Telephone Number

Name

Address

City State Zip Code

Visit http://dor.mo.gov/motorv/licplate.php#templicplate

for additional information.

Please mail your completed application and check made payable to the Department of

Revenue for $8.50 ($5.00 license fee and $3.50 processing fee) to the address listed below.

Vehicle

Information

Year Make License Plate Number

Vehicle Identification Number

(___ ___ ___)___ ___ ___-___ ___ ___ ___

| | | | | | | | | | | | | | | |

___ ___ / ___ ___ / ___ ___ ___ ___

| | | | |

Fillable Printable Form 5429 Temporary License Plate Application