Form 5005 Application/Affidavit For Missouri Repossession
User Manual: 5005
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ANY FALSE STATEMENT IN THIS APPLICATION IS A VIOLATION OF THE LAW AND MAY BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH. DOR USE ONLY-REJECT NUMBER STAPLE HERE TYPE ALL APPLICATIONS - QUESTIONS SHOULD BE REFERRED TO (573) 526-3669. MISSOURI DEPARTMENT OF REVENUE MOTOR VEHICLE BUREAU PO BOX 2076, JEFFERSON CITY MO 65105-2076 (573) 526-3669 www.dor.mo.gov/mvdl OFFICE VALIDATION FORM 5005 APPLICATION/AFFIDAVIT FOR MISSOURI REPOSSESSION TITLE MOTOR VEHICLE BOAT/VESSEL OUTBOARD MOTOR UNIT DESCRIPTION TITLE APPLICANT BOAT/VESSEL/ OUTBOARD MOTOR BRAND CODE (REV. 08-2017) IF UNIT WAS TOWED, RECORD THE NAME OF THE LAW ENFORCEMENT AGENCY THE VEHICLE WAS REPORTED TO: MANUFACTURED HOME TRAILER LIENHOLDER NAME STREET ADDRESS, R.R. OR P.O. BOX NUMBER CITY, STATE, ZIP CODE TELEPHONE NUMBER REPO. TITLE FEES ( ) YEAR FUEL MAKE ® UNIT IDENTIFICATION NUMBER G - GAS L - LP - PROPANE D - DIESEL E - ELECTRIC N - NAT. GAS V - PLUG-IN HYBRID O - OTHER ELEC. VEHICLE KIND OF VEHICLE COLOR $10 REPO. TITLE BODY STYLE $2.50 PROCESSING FEE DEBTOR’S TITLE NO. STATE CURRENT MILEAGE CODE REPOSSESSION DATE OF UNIT KIND OF VEHICLE (K.O.V.) P - PASSENGER M - MOTORCYCLE T - TRUCK C - TRICYCLE D - TRAILER/MANF. HOME R - REC. VEHICLE B - BUS A - ATV (IF TYPING, DISREGARD BLOCK CONSTRAINTS) CYLINDER HORSEPOWER $5 QUICK FEE MODEL NUMBER ® LENGTH MATERIAL FT. BOAT TYPE ENGINE DRIVE TYPE IN. IF MISSOURI TITLE FILL IN FIRST FOUR LETTERS OF PREVIOUS OWNER’S LAST NAME ® BOAT / VESSEL LICENSE ID NUMBER TYPE OF USE MO TYPE OF PROPULSION TAX EXEMPT (#13) TOTAL $ MAIL TO LOCATION 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 SIGNATURE LOC. OF UNIT DEBTOR 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 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 SIGNATURE OF LIENHOLDER’S REPRESENTATIVE (REQUIRED) 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. X NOTARIZATION REQUIRED NOTARY PUBLIC EMBOSSER OR BLACK RUBBER STAMP SEAL STATE COUNTY (OR CITY OF ST. LOUIS) SUBSCRIBED AND SWORN BEFORE ME, THIS DAY OF NOTARY PUBLIC SIGNATURE MY COMMISSION EXPIRES NOTARY PUBLIC NAME (TYPED OR PRINTED) Form 5005 (Revised 08-2017) REQUIRED DOCUMENTS 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. PAYMENT METHODS 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 UNCOLLECTED FUNDS. Other restrictions may also apply. COMPLETING THIS APPLICATION 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. BOAT/VESSEL CODES 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 Inflatable Boat RAF Jet Ski JET Official 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 TYPE OF USE Charter Fishing Commercial Fishing Commercial Passenger Carrying Dealer or Manufacturer Demonstration Other Commercial Operation Pleasure Rent or Lease Form 5005 (Revised 08-2017)
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