Form 4899 - County Collector'S Suspension Notification

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MISSOURI DEPARTMENT OF REVENUE
MOTOR VEHICLE BUREAU
FORM
PO BOX 100
Reset Form
JEFFERSON CITY MO 65105-0100
4899
(573) 526-3669
Print Form
COUNTY COLLECTOR’S SUSPENSION NOTIFICATION
(REV. 4-2005)
TO BE COMPLETED BY THE COUNTY/TOWNSHIP COLLECTOR
DELINQUENT TAXPAYER’S NAME (LAST, FIRST, MIDDLE INITIAL)
ADDRESS
YEAR OF DELINQUENT TAXES
CITY
STATE
ZIP
DATE COLLECTOR NOTIFIED APPLICANT
VEHICLE/TRAILER INFORMATION
DOR USE ONLY
YEAR
MAKE
VEHICLE IDENTIFICATION NUMBER
MODEL
LICENSE NUMBER
EXP. YR.
YEAR
MAKE
VEHICLE IDENTIFICATION NUMBER
MODEL
LICENSE NUMBER
EXP. YR.
YEAR
MAKE
VEHICLE IDENTIFICATION NUMBER
MODEL
LICENSE NUMBER
EXP. YR.
YEAR
MAKE
VEHICLE IDENTIFICATION NUMBER
MODEL
LICENSE NUMBER
EXP. YR.
ATTACH ADDITIONAL SHEET IF NECESSARY
I certify that the vehicle owner/taxpayer listed above has been notified of his or her delinquent personal property taxes and at
least 30 days have elapsed since notification. I request the registrations on the vehicle(s) listed above be suspended.
SIGNATURE OF COUNTY/TOWNSHIP COLLECTOR
COUNTY
DATE
MO 860-2956 (4-2005)

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