Form Mo 860-2566 - Application For Documented Vessel Certificate Of Registration
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1
2ANY FALSE STATEMENT IN THIS APPLICATION IS A VIOLATION OF LAW AND MAY
BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH.
TYPE ALL APPLICATIONS
DOR USE ONLY — REJECT NUMBER
STAPLE
HERE
INSTRUCTIONS ON REVERSE
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OFFICE VALIDATION
MISSOURI DEPARTMENT OF REVENUE
APPLICATION FOR DOCUMENTED VESSEL
CERTIFICATE OF REGISTRATION
MISSOURI
ORIGINAL
DUPLICATE
CORRECTED
TYPE OF REGISTRATION
CERTIFICATE NUMBER:
(CHECK ONE):
DUPLICATE REGISTRATION ONLY
— COMPLETE REASON AND NOTARIZE (SEE BELOW). NOTARY INFORMATION APPLIES TO APPLICANT’S SIGNATURE.
LOST
STOLEN
MUTILATED (ATTACH MUTILATED REGISTRATION)
NEVER RECEIVED — LOST IN MAIL
OWNER’S NAME — LAST, FIRST, MIDDLE
DLN/FEIN NUMBER
Check box and complete information below so that a certificate of registration can be
MISSOURI STREET ADDRESS, R.R. (WHERE VESSEL IS HOUSED OR LOCATED)
MAIL TO
mailed. (If owner’s address is different than to the right or is an out of state address.)
MAILING ADDRESS
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
YEAR
MAKE
MANUFACTURER’S HULL IDENTIFICATION NUMBER
MODEL NUMBER
HORSEPOWER
COLOR
LENGTH
MATERIAL
BOAT TYPE
TYPE OF PROPULSION
FT.
IN.
NEW
USED MO
USED OUT-OF-STATE
U.S. COAST GUARD OFFICIAL NUMBER
EXP. MONTH
EXP. YEAR
SURRENDERED TITLE NUMBER
STATE
DOCUMENTED VESSEL NAME
REGISTRATION DECAL NUMBER
EXPIRATION YEAR
PREVIOUSLY
Copy of the Certificate of Documentation issued by the United States (U.S.) Coast Guard;
DOCUMENTED?
Proof of Ownership (See back of application for acceptable proof) *Must include purchase price and purchase date;
YES
NO
Your paid personal property tax receipt or statement of non-assessment from the county (or City of St. Louis) assessor or collector for
IF DOCUMENTED, LIST
the previous year. The property tax receipt or statement of non-assessment must be in the owner’s name;
STATE
$10.00 fee ($7.50 certification fee and $2.50 processing fee);
A registration and processing fee based on the length of the vessel (see chart on the back of application for fees);
DATE OF PURCHASE
The “in-lieu: watercraft tax based on purchase price of the vessel (see chart on the back of application for fees) or proof that
applicable taxes have been paid (trade-in credit is not accepted); and
Penalty fees as noted on the back of the application, if applicable.
I CERTIFY THAT THE STATEMENTS HEREIN ARE TRUE TO THE BEST OF MY
SIGNATURE OF ONE OWNER REQUIRED
PURCHASE PRICE
KNOWLEDGE. AS THE OWNER OF THE ABOVE MENTIONED VESSEL, I CONSENT
TO ANY INSPECTION NECESSARY TO DETERMINE COMPLIANCE WITH
X
$
PROVISIONS OF 306, RSMo.
MISSOURI BOAT DEALER NUMBER
BOAT DEALER NAME
CITY, STATE, AND ZIP CODE
TELEPHONE NUMBER
FEES
(
)
REGISTRATION FEE
I CERTIFY THAT THE FACTS HEREIN ARE TRUE TO THE BEST OF MY
SIGNATURE OF DEALER OR REPRESENTATIVE
®
$
KNOWLEDGE.
PENALTY
NOTARY PUBLIC EMBOSSER OR BLACK
STATE
COUNTY (OR CITY OF ST. LOUIS)
RUBBER STAMP SEAL
$
SUBSCRIBED AND SWORN BEFORE ME, THIS
OTHER PENALTIES
DAY OF
$
NOTARY PUBLIC SIGNATURE
MY COMMISSION EXPIRES
CERTIFICATION FEE
NOTARY PUBLIC NAME (TYPED OR PRINTED)
$ 7.50
PERSONAL PROPERTY TAX
PROCESSING FEE
REMARKS:
$
FOR DEPARTMENT OF REVENUE USE ONLY
PROCESSED BY
IN-LIEU TAX
$
TEMPORARY PERMIT NUMBER
TEMPORARY PERMIT ISSUE DATE
TEMPORARY PERMIT EXPIRES
TOTAL
MISSOURI CITY OR COUNTY
TEMP PERMIT
$
WHERE THE UNIT IS HOUSED
CONTROL NUMBER
DISTRIBUTION AMT.
$
TOTAL
$
$
MISSOURI RESIDENTS MUST MAKE APPLICATION WITHIN THIRTY (30) DAYS TO AVOID PENALTIES.
MO 860-2566 (10-2007)
DOR-4398 (10-2007)
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