Fillable Form 4576 - Abandoned Property Affidavit printable pdf download

MISSOURI DEPARTMENT OF REVENUE

FORM

MOTOR VEHICLE BUREAU

4576

P O BOX 2076

Reset

JEFFERSON CITY MO 65105-2076

(REV. 1-2010)

ABANDONED PROPERTY AFFIDAVIT

Section 304.156, RSMo, provides that thirty (30) days after a notification form has been mailed to the abandoned property owner and lienholder, if applicable,

and the property is unredeemed and no satisfactory arrangement has been made with the lienholder in possession for continued storage, and the owner or

lienholder, if applicable, has not requested a hearing as provided, the lienholder in possession may apply to the Director of Revenue for an original title,

salvage certificate of title designated with the words “Salvage/Abandoned Property” or junking certificate based on the condition of the abandoned property.

This affidavit must accompany the transaction with Sections A and B completed. See checklist on reverse for other requirements.

ABANDONED PROPERTY TOWED

YEAR

MAKE

MODEL

VEHICLE/VESSEL/OUTBOARD MOTOR IDENTIFICATION NUMBER

__ __ __ __

OWNER

LIENHOLDER

STREET ADDRESS

CITY

STATE

ZIP CODE

CITY

STATE

ZIP CODE

__ __ __ __ __

On (date) __ __ / __ __ / __ __ __ __ , I towed the above mentioned property. I have been in possession of the abandoned property

for at least 30 days and the owner of the abandoned property or lienholder have not made arrangements for payment of towing and

storage charges. I have not been notified of any application for hearing as provided in Section 304.156, RSMo.

If notice to the owner and lienholder of the abandoned property has been returned “Not Forwardable” or “Addressee Unknown,” my

signature on this affidavit certifies that a physical search of the abandoned property disclosed no other evidence of ownership and

that a good faith effort has been performed to establish the prior state of registration and title. The following was searched, if

applicable:

1. The abandoned property for any type of license plates, license plate record, temporary permit, inspection sticker, decal, or

other evidence which may indicate a possible registration and title in another state;

2. The law enforcement report for a license plate number or registration number if the abandoned property was towed at the

request of a law enforcement agency;

3. The tow ticket/report of the tow truck operator to see if a license plate was on the abandoned property at the beginning of

the tow, if a private tow; and

4. The law enforcement report to see if an out-of-state address is indicated on the driver license information if there is no

address of the owner on the impound report.

TOWING COMPANY NAME

SIGNATURE OF TOWER

DATE

__ __ / __ __ / __ __ __ __

NOTARY PUBLIC EMBOSSER OR

STATE

COUNTY (OR CITY OF ST. LOUIS)

BLACK INK RUBBER STAMP SEAL

SUBSCRIBED AND SWORN BEFORE ME, THIS

DAY OF

YEAR

USE RUBBER STAMP IN CLEAR AREA BELOW.

NOTARY PUBLIC SIGNATURE

MY COMMISSION

EXPIRES

NOTARY PUBLIC NAME (TYPED OR PRINTED)

MO 860-2696 (1-2010)

Form 4576 - Abandoned Property Affidavit

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