Fillable Printable General Affidavit Form - Missouri

General Affidavit Form - Missouri

Form 768 (Revised 07-2013)

FORM

768

Missouri Department of Revenue

General Affidavit

Mail to:Motor Vehicle Bureau

P.O. Box 100 Phone: (573) 526-3669

Jefferson City, MO 65105-0100 E-mail: [email protected]

Visit dor.mo.gov/motorv

for additional information.

Certification

rThe motor vehicle described on the attached application has not been operated on public roads or the highways of Missouri

by myself, or my agent during the period of __ __ /__ __ /__ __ __ __ to __ __ /__ __ /__ __ __ __ (Notarization required).

rI am giving this motor vehicle to _____________________________________________ and there is no money or other

valuable consideration involved in the transaction.

rThe vehicle described below has not been in the state of Missouri for the 60 day period immediately preceding the

date of this application for registration and will be submitted for inspection at an official inspection station within 10 days

after entering the state by myself, or my agent.

rThe vehicle described below was abandoned on real estate owned or purchased by me located at (address, city, state):

_____________________________________________________________________________________________

and has an approximate retail and or fair market value of $ _________________. Describe circumstances by which the real

property owner came into possession of the abandoned vehicle: ____________________________________________

______________________________________________________________________________________________

__________________________________________________________________________________________________

rI certify under penalties of perjury that I have written consent from all owners and or lien holders of record to repossess

boat or vessel, or outboard motor, or I have provided all owners and 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. Debtor’s name and location or address of repossessed unit (Notarization and

DOR-93 required): __________________________________________________________________________________

__________________________________________________________________________________________________

I certify that I am seventy-five years old or older and am no longer required to present a physician’s statement at the time

of renewal for disabled person placards or license plates.

rOther ________________________________________________________________________________________

_________________________________________________________________________________________________

Any false statement in this affidavit is a violation of law, and may be punished byfine, imprisonment, or both.

Owner Year Make Model

Vehicle Identification Number Original Title Number Current License Number

Signature of Owner Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __

Notary Information

Subscribed and sworn before me, this

day of year

State County (or City of St. Louis) MyCommission Expires (MM/DD/YYYY)

Notary Public Signature

Notary Public Name (Typed or Printed)

Embosser or black ink rubber stamp seal

__ __ /__ __ /__ __ __ __