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Missouri Department of Revenue
Form
Authorization and Release for License Office
Management, New Personnel, and Officers
5306
License Office
Contract or Office Manager
Telephone Number
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Department Use Only
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Del Comments: ______________________________
MVPPT
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Department of Revenue tax compliance review has been conducted
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Date Notified: ________________________
MSHP
Signature
Date (MM/DD/YYYY)
Signature
Date (MM/DD/YYYY)
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Completion of this form authorizes the Department of Revenue to conduct compliance checks regarding vehicle titling and registration
records and payment of taxes and to initiate a request through the Missouri State Highway Patrol for a criminal background check. The
license office contractor’s long and short account will be debited for the $11 processing fee for each background check performed.
Select one of the following and indicate the position the employee will fill, if applicable.
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Prospective License Office Employee
Position employee will fill:
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Office Manager
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Contract Manager
Clerk
Other ___________________________
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Current License Office Employee at ____________________ License Office. Current Position ________________________
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Position employee will fill:
Office Manager;
Contract Manager
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Person With After-Hours Access Only
Non-Bonded Cleaning Staff
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Officer (Officer does not apply to political subdivisions)
Presiding Officer
This section must be completed by all applicants.
Full Name
Officer’s Title (if applicable)
Social Security Number
Date of Birth (MM/DD/YYYY)
E-mail Address
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Home Telephone Number
Cellular Telephone Number
Fax Number
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Mailing Address
City
State
Zip Code
Only complete spouse’s information if applicant is married and filing joint returns.
Spouse’s Full Name
Spouse’s Social Security Number
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Spouse’s Date of Birth (MM/DD/YYYY)
Spouse’s Cellular Telephone Number
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Spouse’s Mailing Address
City
State
Zip Code
This section must be completed by Prospective License Office Employees, Officers, and Presiding Officers.
List all motor vehicles, trailers, all-terrain vehicles (ATVs), vessels, and outboard motors owned or co-owned by the applicant that are required to
be titled in Missouri. Also, list leased units, if the applicant is responsible for the registration and payment of personal property taxes on the units.
Attach additional sheets if necessary.
Vehicle Identification Number or Missouri Title Number
Year
Make and Model
Form 5306 (Revised 11-2013)
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