Form 570 - Application For Missouri Historic Or Personalized Historic License Plates
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Missouri Department of Revenue
Application for Missouri Historic or
FORM
570
Personalized Historic License Plates
Any false statement in this application is a violation of the law and may be punished by fine or imprisonment or both.
Owner’s Name (as shown on the title)
DLN/FEIN Number
Street Address or R.F.D.
County
City, State, Zip Code
Telephone Number
(__ __ __) __ __ __ - __ __ __ __
Year
Make
Vehicle Identification Number
Title Number
Body Style
Kind of Vehicle
Historic License Number
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Historic (Fee - $25.25 Permanent Registration and a $3.50 Processing Fee)
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Personalized Historic (Fee - $15.00 Personalized Fee in addition to the $25.25 Permanent Registration Fee and a $3.50
Processing Fee) If you currently have a historic plate on the above vehicle, the $25.25 is not due. Please indicate your
current license number in the Historic License Number area. If the requested configuration is already issued for a vehicle you
own, the plates must be surrendered with this application.
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Year of Manufacture (Fee - $25.25 Permanent Registration and a $3.50 Processing Fee) If you possess a license plate
issued by the state of Missouri that is over 25 years old in which the year of the issuance of such plate is consistent with the
model year of the vehicle, you may register the plate as a historic vehicle plate. Submit a picture of the plate with this application.
Year of Manufacture Plate Number
Year That Appears on Plate (original expiration)
See reverse side for instructions on selecting your personalized license plate. Please use all capital letters and show choices in
order of preference. Personalized license plates may consist of no more than six characters or six characters plus a dash, space,
or an apostrophe. A personalized motorcycle license plate may consist of no more than six characters or five characters plus a
space, dash, or apostrophe.
I hereby make application for the following personalized license plate to be issued to the above named owner(s).
First Choice
Second Choice
Third Choice
Fourth Choice
Sixth Choice
Fifth Choice
Description of what the
Description of what the
Description of what the
Description of what the
Description of what the
Description of what the
configuration above stands for.
configuration above stands for.
configuration above stands for.
configuration above stands for.
configuration above stands for.
configuration above stands for.
If your choice(s) for a personalized historic or year of manufacture license plate is not available, your application will be rejected
and returned to you and your fees will be retained and applied to your corrected application when it is returned unless you
specifically request a refund of your fees. If your choice for a personalized license plate is available, you will receive your license
plates in approximately four to six weeks.
You must present your insurance card (a copy is acceptable) or other acceptable proof of financial responsibility with this
application. Any false affidavit is a crime under Section 575.050 of Missouri law. The signature below shall certify that I have and
will maintain, during the period of registration, financial responsibility with respect to each motor vehicle that I own, license, or
operate on the streets or highways. I hereby affirm that the statements herein are true, that this vehicle is over 25 years old, is
owned solely as a collector’s item, and will be used for exhibition and educational purposes.
Printed Name of Owner
Date (MM/DD/YYYY)
__ __ /__ __ /__ __ __ __
Signature of Owner
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Personal Property Tax Receipt
Insurance Verified By _________________________________________________________
Form 570 (Revised 06-2013)
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