Missouri Department Of Revenue Application For Missouri Boat/vessel Or Outboard Motor Title And Registration

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ANY FALSE STATEMENT IN THIS APPLICATION IS A VIOLATION OF LAW AND MAY
BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH.
TRANS TYPE
TITLE AND NOTICE OF LIEN
(NO COMPLETE CHANGE OF OWNERSHIP)
BOAT/VESSEL
DOR USE ONLY - REJECT NUMBER
OUTBOARD MOTOR
TITLE ONLY
TITLE AND
INSTRUCTIONS ON REVERSE
REGISTRATION
CLICK HERE for instructions before printing this form.
OFFICE VALIDATION
MISSOURI DEPARTMENT OF REVENUE
APPLICATION FOR MISSOURI BOAT/VESSEL OR
OUTBOARD MOTOR TITLE AND REGISTRATION
ORIGINAL (1) DUPLICATE (2)
REPOSSESSION (4) CORRECTED (5) MECHANIC LIEN (6) SALV. ABAND. (9)
DUPLICATE SALV. ABAND. (0)
JUNK (A)
DUP. JUNK (B)
TRANSFER ON
TENANTS
DEATH (TOD)
IN COMMON
OWNER’S NAME - LAST, FIRST, MIDDLE (ONLY FIRST 38 POSITIONS WILL PRINT ON TITLE) INCLUDING TOD
TOD BENEFICIARIES, IF APPLICABLE
STREET ADDRESS (MUST BE A PHYSICAL ADDRESS - CANNOT BE A PO BOX OR RURAL ROUTE)
COUNTY
L/R NUMBER
IN CITY LIMITS
OUTSIDE CITY LIMITS
CITY
STATE
ZIP CODE
DLN OR FEIN NUMBER
TELEPHONE NUMBER
ENTER 2 LETTER
(
)
ABBREVIATION
YEAR MFD.
MODEL YEAR - NEW
MAKE
MANUFACTURER’S HULL IDENTIFICATION NUMBER
MODEL NUMBER
OUTBOARD MOTOR ONLY
HORSEPOWER
COLOR
LENGTH
MATERIAL
BOAT TYPE
TYPE OF PROPULSION
FT.
IN.
CLICK ON FUEL TYPE
NEW
USED MO
USED OUT-OF-STATE
FUEL
FIRST FOUR LETTERS OF PREVIOUS
SURRENDERED TITLE NUMBER
STATE
OWNER’S LAST
G - GAS
E - ELECTRIC
ENTER 2 LETTER
NAME ®
D - DIESEL
O - OTHER
ABBREVIATION
BOAT/VESSEL LICENSE I.D.
TYPE OF USE (CHECK ONE)
BOAT/VESSEL/OUTBOARD MOTOR
EXPIRATION YEAR
PLEASURE
RENTAL
OFFICIAL
NUMBER
DECAL NUMBER
MO
COMMERCIAL PASSENGER
COMMERCIAL FISHING
COMMERCIAL OTHER
FIRST LIEN
SECURITY AGREEMENT DATE
MAIL TO LIENHOLDER
LIENHOLDER’S PHONE NO.
SECOND LIEN
MAIL TO ALTERNATE ADDRESS BELOW. DO NOT USE
(B)
IF SECOND LIEN OR SUBJECT TO FUTURE ADVANCES.
YES
NO
(
)
YES
NO
SECURITY AGREEMENT DATE
1
FIRST LIEN
2
SECOND LIEN/MAIL TO
STFA
STREET ADDRESS, R.R., OR P.O. BOX NUMBER
STREET ADDRESS, R.R., OR P.O. BOX NUMBER
PURCHASE DATE
PRICE
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
ENTER 2 LETTER
ENTER 2 LETTER
$
ABBREVIATION
ABBREVIATION
REBATE
YEAR
MAKE
TITLE NUMBER
MANUFACTURER’S I.D. NUMBER
TRADE-IN
$
TRADE-IN
FIRST LIENHOLDER AUTHORIZES SECOND LIEN BY SIGNING HERE
$
SIGNATURE OF ONE OWNER REQUIRED
OTHER CREDIT
I CERTIFY THAT THE STATEMENTS HEREIN ARE TRUE TO THE BEST OF MY
KNOWLEDGE. AS THE OWNER OF THE ABOVE MENTIONED BOAT/VESSEL
$
OR OUTBOARD MOTOR, I CONSENT TO ANY INSPECTION NECESSARY TO
NET PRICE
X
DETERMINE COMPLIANCE WITH PROVISIONS OF 306, RSMo.
0.00
$
MISSOURI BOAT DEALER NUMBER
BOAT DEALER NAME
CITY, STATE, AND ZIP CODE
TELEPHONE NUMBER
FEES
(
)
REGISTRATION FEE
SIGNATURE OF DEALER OR REPRESENTATIVE
TRADE-IN
I CERTIFY THAT THE FACTS HEREIN ARE TRUE TO
$
®
THE BEST OF MY KNOWLEDGE.
YES
NO
MOZ/MOZA/REPLACE-
MENT NUMBER FEE
DUPLICATE TITLE ONLY — CHECK THE APPROPRIATE BOX
LOST
STOLEN
MUTILATED (ATTACH MUTILATED TITLE)
NEVER RECEIVED — LOST IN MAIL
$
NOTARY PUBLIC EMBOSSER OR BLACK
STATE
COUNTY (OR CITY OF ST. LOUIS)
TITLE PENALTY
RUBBER STAMP SEAL
$
SUBSCRIBED AND SWORN BEFORE ME, THIS
TITLE/QUICK FEE
DAY OF
$
NOTARY PUBLIC SIGNATURE
MY COMMISSION EXPIRES
STATE TAX
NOTARY PUBLIC NAME (TYPED OR PRINTED)
$
LOCAL TAX
SITE CODE
OFFICE VALIDATION ONLY
APPROVE
$
REJECT
PROCESSING OR AGENT
FEE
PROCESSED BY
PP
$
MISSOURI CITY OR COUNTY
NOL PROCESSING FEE
WHERE THE UNIT IS HOUSED
$
TOTAL
CLICK HERE for information regarding state and local taxes.
0.00
$
SHADED BOXES FOR BOAT/VESSEL ONLY
DOR-93 (07-2013)

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