Fillable Form 426 - Vehicle And Marine Request For Refund printable pdf download

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MISSOURI DEPARTMENT OF REVENUE

FORM

ADMINISTRATION DIVISION

426

P.O. BOX 87, JEFFERSON CITY, MO 65105-0087

(573) 751-4792

Fax: 573-522-2548 E-mail: mvrefund@dor.mo.gov

VEHICLE AND MARINE REQUEST FOR REFUND

(REV. 06-2012)

Refunds cannot be processed without complete information.

CLAIMANT’S NAME (PRINT)

CLAIMANT’S E-MAIL (OPTIONAL)

MAILING ADDRESS

PHONE NUMBER

(__ __ __) __ __ __ - __ __ __ __

CITY

STATE

ZIP CODE

__ __ __ __ __

I am requesting a refund in the amount of:

(optional)

$__________.____

To ensure your refund can be processed in a timely manner, please review the frequently asked questions on the back of this form

and check the box below that applies to you. A unit is a motor vehicle, boat, outboard motor or trailer.

If you purchased or contracted to purchase a unit and sold a different unit within 180 days before or after the purchase, please

submit the following information:

Vehicle and Marine Request for Refund (Form 426)--properly completed and signed;

Missouri Title Receipt--a legible copy for the unit that was purchased showing taxes and fees paid;

Bill of sale or Notice of Sale--properly completed and signed for the unit that was sold; and

Original proof of ownership from your previous state of residence if you sold the vehicle on an out-of-state title (i.e., original

registration receipt or certified title record from your previous state).

If you experienced a total loss and, after the date of the total loss, you purchased or contracted to purchase a replacement unit

within 180 days after the date of the total loss payment from the insurance company, please submit the following information:

Vehicle and Marine Request for Refund (Form 426)--properly completed and signed;

Missouri Title Receipt--a legible copy for the unit purchased showing taxes and fees paid;

Notarized total loss affidavit from the insurance company--properly completed, signed, and notarized or if uninsured or liability

insurance only, provide two appraisals and a copy of the police report; and

Original proof of ownership from your previous state of residence if you sold the vehicle on an out-of-state title (i.e., original

registration receipt or certified title record from your state).

If you were overcharged on your local tax rate, please submit the following:

Vehicle and Marine Request for Refund (Form 426)--properly completed and signed;

Legible copy of your Missouri Title Receipt--showing the overcharge; and

Legible copy of a Tax Waiver, a statement from the county or city collector, or a personal property tax receipt verifying the city (if you

live in the city limits) and county where you reside.

I f you returned a unit to a dealer within 60 days from the date of purchase, please submit the following:

Vehicle and Marine Request for Refund (Form 426)--properly completed and signed;

Non-interest statement from the lienholder (if you have a lienholder);

Statement from the seller/dealer indicating the sale was rescinded. The statement must include the date the unit was returned, the

amount of the purchase price returned to the buyer, and the reason why the unit was returned; and

Copy of the Missouri Title Receipt.

I f you are applying for a refund of license plates/tab fees:

Vehicle and Marine Request for Refund (Form 426)--properly completed and signed;

Renew Motor Vehicle Registration Receipt - a legible copy showing fees paid;

Submit the unused license plates/tabs; and

If you no longer own the unit, surrender the license plates associated with the unused tabs purchased.

F or all other requests for refunds, please submit a detailed explanation and a legible copy of the receipt reflecting the overcharge.

____________________________________________________________________________________________________________

I declare this claim and any attached information supporting the claim is true, complete, and correct.

APPLICANT’S/CLAIMANT’S SIGNATURE

DOR-426 (06-2012)

Form 426 - Vehicle And Marine Request For Refund

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