Form 4441 - Statement Of Trust

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FORM
MISSOURI DEPARTMENT OF REVENUE
4441
MOTOR VEHICLE BUREAU
STATEMENT OF TRUST
(REV. 9-2009)
1. The following Trust is the subject of this statement:
TRUST NAME
TRUST DATE
___ ___ /___ ___ / ___ ___ ___ ___
FEDERAL TRUST I.D. NUMBER
GRANTOR’S NAME
GRANTOR’S ADDRESS
2. The Trustee(s) currently serving are:
NAME
NAME
NAME
NAME
NAME
3. The Trust is currently in full force and effect.
4. We certify that we are the acting Trustees and have been granted, by the terms of the trust, unlimited authority to sell,
assign, dispose, or otherwise transfer any interest in any vehicles/vessels/outboard motors/manufactured homes to or
from this trust.
5. We certify that the foregoing statements are true and correct under penalty of perjury.
COUNTY (OR CITY OF ST. LOUIS)
DATE
__ __ / __ __ / __ __ __ __
This statement was executed at
County, Missouri on
By execution of this document, the undersigned acknowledges that all information contained on this form is a public
record under Chapter 610 and may be disclosed upon proper request.
SIGNATURE OF THE TRUSTEE(S)
MO 860-2607 (9-2009)

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