Form 5175 - Request For Additional Plates For Official State Vehicles
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1MOTOR VEHICLE BUREAU
FORM
(573) 751-5709
5175
REQUEST FOR ADDITIONAL PLATES
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FOR OFFICIAL STATE VEHICLES
(REV. 4-2008)
AGENCY OR UNIVERSITY NAME:
DATE:
__ __ / __ __ / __ __ __ __
CONTACT NAME:
CONTACT PERSON’S EMAIL ADDRESS:
AGENCY PHONE NUMBER:
AGENCY FAX NUMBER:
PLATE REQUESTED:
J
J
J
J
New Vehicle
New Trailer
New Motorcycle
Replacement Vehicle/Trailer
# of Plates Requested ______________
THIS FORM IS NOT REQUIRED WHEN YOU REPLACE A VEHICLE/TRAILER WITHIN 90 DAYS,
AND USE THE PLATE ASSIGNED FROM THE PRIOR VEHICLE/TRAILER.
AGENCY HEAD OR DESIGNEE ____________________________________________
DATE __ __ / __ __ / __ __ __ __
INSTRUCTIONS
Complete & Submit Request for Additional Official Plates by clicking on the submit button below
or mail to:
Missouri Department of Revenue
Motor Vehicle Bureau
Submit form by e-mail
Attention: Tammy Baker
PO Box 100
Jefferson City, MO 65105-0100
(Allow 21 days for new plates to arrive).
Upon completion, form will be returned to you with a tracking number and the plate number(s)
ordered. Please submit this form along with the following documents when registering the vehicle(s):
1. Application for Title and or License (DOR 108)
2. Application for License Only (DOR-184)
3. Appropriate Ownership Documents.
4. Safety/Emissions Inspection if Applicable.
OFFICE OF ADMINISTRATION ONLY
FLEET MANAGER _______________________________________________________
DATE __ __ / __ __ / __ __ __ __
DEPARTMENT OF REVENUE USE ONLY
TRACKING NUMBER ________________________
PLATE NUMBER(S) ORDERED_______________________________________________
DATE PLATE(S) ORDERED __ __ / __ __ / __ __ __ __
DOR-5175 (4-2008)
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