Fillable Form 5043 - Notice Of Vehicle Titling Requirements printable pdf download

MOTOR VEHICLE BUREAU

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FORM

PO BOX 2076, JEFFERSON CITY MO 65101-2076

5043

(573) 526-3669

NOTICE OF VEHICLE TITLING REQUIREMENTS

(REV. 8-2011)

INSTRUCTIONS TO VEHICLE OWNER: In accordance with Section 301.020, RSMo, the Department of Revenue (department) has

been notified that a total loss claim payment has been paid to the vehicle owner listed below. The vehicle was less than seven years old

at the time of damage and the damage exceeds 80 percent of the pre-damaged fair market value of the vehicle as recorded below

and therefore qualifies the vehicle as a salvage vehicle. You must apply for a salvage or prior salvage title by submitting the requirements

in Section A or B.

If the vehicle is not operable, you must obtain a salvage title by submitting the following items within 30 days to your local contract

office or to the address above.

1. Application for Missouri Title and License (DOR-108), marked Salvage;

2. Original Certificate of Title for the damaged vehicle listed below;

3. A notarized lien release if a lien is recorded on the face of the original Certificate of Title, if applicable;

Note: If a notarized lien release is not submitted, the lien will be recorded on the face of the Salvage Certificate of Title.

4. A copy of this form;

5. $8.50 title fee and $2.50 processing fee; and

6. $5.00 quick title fee, if applicable.

If the vehicle is operable (regardless of whether or not repairs have been made), you may obtain a prior salvage title by submitting

the following items within 30 days to your local contract office or to the address above.

1. Application for Missouri Title and License (DOR-108), marked Prior Salvage;

2. Original Certificate of Title for the damaged vehicle listed below;

3. An inspection from an Official Safety Inspection Station:

a. A current safety inspection not more than 60 days old if the vehicle will be registered; or

b. An Identification/Odometer (ID/OD) inspection if the vehicle will not be registered at this time.

4. A copy of this form;

5. $8.50 title fee and $2.50 processing fee; and

6. $5.00 quick title fee, if applicable.

Once a Certificate of Title branded as “Prior Salvage” has been issued, and the vehicle has been safety inspected, the current vehicle

license plates may be affixed to the vehicle and it may be driven on the roadways.

INSTRUCTIONS TO INSURANCE COMPANY

By completing this form, you are certifying that the vehicle was less than seven years old at the time of damage and the damage exceeds 80

percent of the pre-damaged fair market value of the vehicle. This form must be completed and sent to the vehicle owner who is retaining ownership

of the salvaged vehicle no later than 30 days after a total loss claim payment has been made. Copies of the completed form must be sent to the

lienholder and the Department of Revenue.

VEHICLE OWNER(S) NAME

ADDRESS

CITY

STATE

ZIP CODE

VEHICLE LICENSE PLATE NUMBER

VEHICLE YEAR

MAKE

MODEL

VEHICLE IDENTIFICATION NUMBER

INSURANCE COMPANY NAME

ADDRESS

CITY

STATE

ZIP CODE

TELEPHONE NUMBER

(__ __ __) __ __ __ – __ __ __ __

CLAIM NUMBER

DATE OF LOSS

DATE OF PAYMENT

__ __ / __ __ / __ __ __ __

I hereby certify under penalty of perjury that the information above is true and accurate and is made without intent to defraud.

SIGNATURE OF AUTHORIZED AGENT

DOR-5043 (8-2011)

Form 5043 - Notice Of Vehicle Titling Requirements

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