Form 5044 - Notice Of Failure To Present Certificate Of Title
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MOTOR VEHICLE BUREAU
FORM
PO BOX 100, JEFFERSON CITY MO 65101-0100
5044
(573) 526-3669
NOTICE OF FAILURE TO PRESENT CERTIFICATE OF TITLE
(REV. 7-2010)
You have failed to present a Certificate of Title to the insurance company that acquired the vehicle described below
through the claims adjustment process. As the vehicle owner and lienholder you are hereby notified that you must
present a Certificate of Title on this vehicle within 30 days to the insurance company named below. Failing to present
a Certificate of Title will allow the insurance company to obtain a Salvage Certificate of Title or Junking Certificate
and have legal ownership of the vehicle.
VEHICLE OWNER(S) NAME
ADDRESS
CITY
STATE
ZIP CODE
VEHICLE YEAR
MAKE
MODEL
VEHICLE IDENTIFICATION NUMBER
FIRST LIENHOLDER
ADDRESS
CITY
STATE
ZIP CODE
SECOND LIENHOLDER
ADDRESS
CITY
STATE
ZIP CODE
To contest the insurance company obtaining a Salvage Certificate of Title or Junking Certificate for the vehicle
above, you must file a petition in the Circuit Court in the county where the vehicle is located within 30 days of receipt
of this notice. The petition must show the insurance company as the defendant. The Director of Revenue must be
served with a copy of the petition, but is not a defendant in the case.
INSURANCE COMPANY NAME
ADDRESS
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
(
)
SIGNATURE OF AUTHORIZED AGENT
DATE
INSTRUCTIONS TO INSURANCE COMPANY
Complete the information above and mail this notification to the vehicle owner and lienholder of record by certified
mail. If the owner does not present the Certificate of Title within 30 days you may apply for a Salvage Certificate of
Title or Junking Certificate by submitting the following items to the Department of Revenue:
1. Application for Missouri Title and License (DOR-108), marked Salvage or Junking Certificate;
2. Vehicle Examination Certificate (DOR-551) completed by any law enforcement agency;
3. A copy of this form;
4. Certified mail receipt(s) containing recipient’s signature(s);
5. $8.50 title fee (No title fee is required for a Junking Certificate.);
6. $2.50 processing fee; and
7. $5.00 quick title fee, if applicable.
MO 860-3028 (7-2010)
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