Form 2300 - Application For Special Fuel Decal
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MISSOURI DEPTARTMENT OF REVENUE
MOTOR VEHICLE BUREAU
PO BOX 2076
FORM
JEFFERSON CITY MO 65105-0100
SEE INSTRUCTIONS
2300
(573) 526-3669
APPLICATION FOR
ON REVERSE
(REV. 12-2012)
SPECIAL FUEL DECAL
VALIDATION USE ONLY
APPLICANT’S NAME (LAST, FIRST, MIDDLE)
DLN OR FEIN
STREET, R.R., OR P.O. BOX NUMBER
COUNTY
CITY, STATE, ZIP CODE
TELEPHONE NUMBER
(_ _ _) _ _ _ - _ _ _ _
VEHICLE INFORMATION
YEAR
MAKE
VEHICLE IDENTIFICATION NUMBER
TYPE OF FUEL
__ __
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
CURRENT LIC. NO.
EXP. YR.
WEIGHT
ZONE
KOV
FARM PLATE
__ __
YES
NO
NEW
RENEWAL DECAL
PREV. DECAL NO.
EXP. YR.
NEW DECAL NUMBER
EXP. YR.
DECAL FEE
__ __
__ __
CHANGE OF WEIGHT
PREV. LIC. PLATE
EXP. YR.
PREV. WT. CURRENT DECAL NO.
EXP. YR.
DECAL FEE
__ __
__ __
TRANSFER —
IF THE OWNERSHIP OF THE DECAL IS BEING TRANSFERRED, COMPLETE THE FOLLOWING:
DECAL TRANSFERRED
EXP. YR.
DECAL FEE
NONE
__ __
PREVIOUS OWNER’S NAME (FIRST, LAST, MIDDLE)
STREET, R.R., OR P.O. BOX NUMBER
CITY, STATE, ZIP CODE
REPLACEMENT DECAL —
COMPLETE THE FOLLOWING:
REASON REQUIRED
LOST
STOLEN
MUTILATED
DESTROYED
PREVIOUS DECAL NUMBER
EXP. YR.
NEW DECAL NUMBER
EXP. YR. DECAL FEE
__ __
__ __
SIGNATURE OF APPLICANT
IMPORTANT: WHEN REQUESTING REPLACEMENT DECAL, THIS APPLICATION MUST BE NOTARIZED
NOTARY PUBLIC EMBOSSER OR BLACK
STATE
COUNTY (OR CITY OF ST. LOUIS)
RUBBER STAMP SEAL
SUBSCRIBED AND SWORN BEFORE ME, THIS
DAY OF
NOTARY PUBLIC SIGNATURE
MY COMMISSION EXPIRES
NOTARY PUBLIC NAME (TYPED OR PRINTED)
OFFICE USE ONLY
APPROVED BY
DISTRIBUTION: WHITE — OFFICE/AUDIT COPY; PINK — APPLICANT’S COPY
DOR-2300 (12-2012)
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