Form 923 - Application For Replacement Of Vehicle, Vessel, Or Trailer Identification Number Plate

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Missouri Department of Revenue
Application for Replacement of Vehicle,
Form
923
Vessel, or Trailer Identification Number Plate
Office Validation
Control Number
Registered Owner (last, first, middle)
Dealer Number
County
Telephone Number
(__ __ __) __ __ __ - __ __ __ __
Street, RR, or PO Box Number
City
State
Zip Code
Motor Vehicle or Trailer
Year
Make
Body Style
Vehicle Identification Number
Missouri Title No.
License Number
Loss of VIN, Plate Reported To
Date (MM/DD/YYYY)
Color
Reason Required
r
r
r
r
__ __/__ __/__ __ __ __
Lost
Stolen
Mutilated
Destroyed
Vessel or Outboard Motor
Year
Make
Model Number
Hull Identification Number
Missouri Title No.
Registration No.
HP
Color
Length
Material
Type of Propulsion
Loss of VIN, Plate Reported To
Date (MM/DD/YYYY)
Reason Required
r
r
r
r
__ __/__ __/__ __ __ __
Lost
Stolen
Mutilated
Destroyed
Signature
Applicant’s Signature
I certify that the statements above are true and that I am the
registered owner of the above described unit(s).
®
Subscribed and sworn before me, this
Embosser or black ink rubber stamp seal
day of
year
State
County (or City of St. Louis)
My Commission Expires (MM/DD/YYYY)
__ __ /__ __ /__ __ __ __
Notary Public Signature
Notary Public Name (Typed or Printed)
For Authorized Law Enforcement Agency Use Only - Do Not Write Below this Line
I certify that on _____________ I physically inspected the above described vehicle, vessel, or outboard motor after the applicant provided
satisfactory proof of ownership and found the vehicle or hull identification number(s) to be:
Public VIN
r
The VIN plate listed below must be surrendered at the time a new
replacement number is issued.
Police VIN
_______________________________________________
Law Enforcement Agency
File No.
Examining Officer’s Signature
Telephone Number
Badge No.
(__ __ __) __ __ __ - __ __ __ __
I certify that on __________________ I did affix the replacement plate, control number ______________________________ issued by the
Department of Revenue to the above vehicle.
r
The outstanding VIN plate listed above has been surrendered and forwarded to the Missouri State Highway Patrol, Auto Theft Unit.
Law Enforcement Agency
Law Enforcement Officer
Badge No.
Remarks and Discrepancies Noted
Form 923 (Revised 8-2013)

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