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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
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
APPLICATION/AFFIDAVIT FOR MISSOURI REPOSSESSION TITLE
BOAT/VESSEL/
BOAT/VESSEL OUTBOARD MOTOR
UNIT DESCRIPTION TITLE APPLICANT
OUTBOARD MOTOR
MOTOR VEHICLE
BRAND CODE
TYPE ALL APPLICATIONS - QUESTIONS SHOULD BE REFERRED TO (573) 526-3669.
5005 (REV. 09-2011)
TRAILER
MANUFACTURED IF UNIT WAS TOWED, RECORD THE NAME OF THE LAW ENFORCEMENT AGENCY THE VEHICLE WAS REPORTED TO: HOME
LIENHOLDER NAME
STREET ADDRESS, R.R. OR P.O. BOX NUMBER
CITY, STATE, ZIP CODE
TELEPHONE NUMBER
REPO. TITLE FEES
( ) YEAR
FUEL
MAKE
G - GAS
UNIT IDENTIFICATION NUMBER
P - PROPANE
E - ELECTRIC ® DN -- DIESEL NATURAL O - OTHER
KIND OF VEHICLE
COLOR
CYLINDER
HORSEPOWER
REPOSSESSION DATE OF UNIT
MATERIAL FT.
BOAT TYPE
TYPE OF PROPULSION
IN.
IF MISSOURI TITLE FILL IN FIRST FOUR LETTERS OF PREVIOUS OWNER’S LAST NAME
®
BOAT / VESSEL LICENSE ID NUMBER
$2.50 PROCESSING FEE
$5 QUICK FEE
MODEL NUMBER
®
LENGTH
$10 REPO. TITLE
BODY STYLE
DEBTOR’S TITLE NO. STATE CURRENT MILEAGE CODE 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)
PLEASURE
RENTAL
TAX EXEMPT (#13)
TOTAL
TYPE OF USE (CHECK ONE)
MO
COMMERCIAL
$
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
NOTARIZATION REQUIRED
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
NOTARY PUBLIC EMBOSSER OR BLACK RUBBER STAMP SEAL
STATE
SUBSCRIBED AND SWORN BEFORE ME, THIS
COUNTY (OR CITY OF ST. LOUIS)
DAY OF
NOTARY PUBLIC SIGNATURE
NOTARY PUBLIC NAME (TYPED OR PRINTED)
MY COMMISSION EXPIRES
DOR-5005 (09-2011)
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 YELLOW
WHI YEL
TYPE OF PROPULSION CODE INBOARD/OUTBOARD I/O INBOARD INB MANUAL MAN OUTBOARD OUT SAIL/INBOARD AUXILIARY S/I SAIL/OUTBOARD AUXILIARY S/O SAIL SAIL TYPE OF VESSEL AIRBOAT AMPHIBIOUS BASS BOAT CANOE COMMERCIAL CRUISER DAYCRUISER DECK BOAT DRAG OR PERFORMANCE BOAT HOVERCRAFT HYDROPLANE
CODE AIR AMP BAS CAN COM CRU DAY DEC DRG HOV HRO
HOUSEBOAT HYDROFOIL JET SKI OFFICIAL PONTOON INFLATABLE BOAT RUNABOUT SAILBOAT SURF JET UTILITY WET BIKE YACHT TYPE OF MATERIAL ALUMINUM CONCRETE FIBERGLASS HYPAL KEVLA (TYPE OF FIBERGLASS) PLASTIC RUBBER STEEL WOOD
HSE HYD JET OFF PON RAF RUN SAL SUR UTL WET YAT CODE ALUM CONCR FGLAS HYPAL KEVLA PLAS RUBBR STEEL WOOD DOR-5005 (09-2011)
