Form 4205 - Date Of Sale Verification

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MISSOURI DEPARTMENT OF REVENUE
MISSOURI STATUTE 301.210 REQUIRES THE TITLE TO
FORM
MOTOR VEHICLE BUREAU
4205
BE ASSIGNED ON THE DAY OF PURCHASE
PO BOX 100, JEFFERSON CITY MO 65105-0100
QUESTIONS SHOULD BE REFERRED TO (573) 526-3669.
DATE OF SALE VERIFICATION
(REV. 05-2013)
YEAR
MAKE
VEHICLE IDENTIFICATION NUMBER (VIN)
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
ISSUE DATE INDICATED ON FACE OF TITLE (MM/DD/YYYY)
ORIGINAL SALE/PURCHASE DATE INDICATED ON ASSIGNMENT OF TITLE (MM/DD/YYYY)
___ ___ / ___ ___ / ___ ___ ___ ___
___ ___ / ___ ___ / ___ ___ ___ ___
Please indicate below a sale/purchase date that was on or after the certificate of ownership (title) issue date. The seller, buyer, and
lienholder(s) if applicable, must sign below. Only one buyer and seller must sign.
NEW SALE OR PURCHASE DATE (MM/DD/YYYY) — MUST BE ON OR AFTER ISSUE DATE ON TITLE
LIENHOLDER’S SIGNATURE
___ ___ / ___ ___ / ___ ___ ___ ___
SELLER’S SIGNATURE
LIENHOLDER’S SIGNATURE
BUYER’S SIGNATURE
DOR-4205 (05-2013)

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