Form 2519 - Request For Receipt Of Title And/or Registration
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MISSOURI DEPARTMENT OF REVENUE
FORM
MOTOR VEHICLE BUREAU
2519
REQUEST FOR RECEIPT OF TITLE
AND/OR REGISTRATION
(REV. 3-2011)
THIS RECEIPT IS FOR PROOF OF PAYMENT ONLY. TO APPLY FOR A DUPLICATE TITLE,
PLEASE SEE FORM DOR-108, APPLICATION FOR MISSOURI TITLE AND LICENSE .
TYPE
TITLE RECEIPT
REGISTRATION RECEIPT
(SHOWING TAX PAID)
(SHOWING PURCHASE OF LICENSE)
REASON REQUIRED:
LOST
STOLEN
MUTILATED
DESTROYED
VALIDATION
OWNER’S LEGAL NAME
STREET ADDRESS, R.R. OR P.O. BOX
COUNTY
CITY
STATE
ZIP CODE
__ __ __ __ __
VEHICLE INFORMATION
YEAR
MAKE
VEHICLE IDENTIFICATION NUMBER
__ __ __ __
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
KIND OF VEHICLE
LICENSE PLATE NUMBER
TITLE NUMBER
__ __ __ __ __ __
ANY FALSE STATEMENT IN THIS APPLICATION IS A VIOLATION OF THE LAW AND MAY BE PUNISHED
BY FINE OR IMPRISONMENT OR BOTH. FORM MUST BE COMPLETED IN FULL AND NOTARIZED.
I HEREBY MAKE APPLICATION FOR A TITLE/REGISTRATION RECEIPT. I CERTIFY THAT
I AM THE OWNER OR JOINT OWNER OF THE VEHICLE DESCRIBED ABOVE.
SIGNATURE OF OWNER
DATE
__ __ /__ __ / __ __ __ __
NOTARY INFORMATION
STATE
SUBSCRIBED AND SWORN BEFORE ME THIS
DAY OF
NOTARY PUBLIC NAME (TYPE OR PRINTED)
NOTARY PUBLIC SIGNATURE
MY COMMISSION
EXPIRES
NOTARY PUBLIC EMBOSSER SEAL
COUNTY (OR CITY OF ST. LOUIS)
USE RUBBER STAMP IN CLEAR AREA BELOW.
MO 860-0378 (3-2011)
DISTRIBUTION: WHITE—OFFICE YELLOW—AUDIT PINK—CUSTOMER
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