FIRST LIEN

STREET ADDRESS, R.R. OR P.O. BOX NUMBER STREET ADDRESS, R.R. OR P.O. BOX NUMBER

CITY STATE ZIP CODE CITY STATE ZIP CODE

NET PRICE

$

OTHER CREDIT

$

IF NEW, LIST GVWR MILEAGE CODE VEHICLE TRADE-IN

$

YEAR MAKE VEHICLE IDENTIFICATION NUMBER (IF TYPING, DISREGARD BLOCK CONSTRAINTS) BODY STYLE REBATE

$

TRANS TYPE

RENEWAL/TRANSFER PLATES

TRANSFER PLATES

NEW PLATES

TITLE ONLY

S

U

YEAR MAKE LICENSE NUMBER EXP. YEAR

VEHICLE IDENTIFICATION NUMBER H.P. TITLE NUMBER

“I CERTIFY UNDER PENALTY OF PERJURY THAT THE FACTS HEREIN ARE TRUE TO THE BEST OF MY KNOWLEDGE.”

FIRST LIENHOLDER AUTHORIZES SECOND LIEN BY SIGNING HERE: ®

OFFICE VALIDATION

MISSOURI DEPARTMENT OF REVENUE

APPLICATION FOR MISSOURI TITLE AND LICENSE

TITLE WITHIN THIRTY DAYS TO AVOID PENALTY DOR-108 (02-2012)

ANY FALSE STATEMENT IN THIS APPLICATION IS A VIOLATION OF THE LAW AND MAY BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH.

DOR USE ONLY — REJECT NUMBER

TITLE AND NOTICE OF LIEN(No complete change of ownership)

LICENSE PLATE NO BRAND CODE

ORIGINAL (1) DUPLICATE (2) NON-NEGOT. (3) PRIOR SALVAGE CORRECTED (5) MECHANIC LIEN (6) SALVAGE (9) DUP. SALVAGE (0) JUNK (A) DUP. JUNK (B) TRANSFER ON TENANTS DEATH (TOD) IN COMMON

OW

NE

RV

EH

ICL

EL

IEN

/MA

IL T

OT

RA

DE

-IN

/T

RA

NS

FE

RO

WN

ER

SIG

NA

TU

RE

DE

AL

ER

INF

O.

NO

TA

RY

- D

UP

LIC

AT

E

TIT

LE

ON

LY

COLOR FUEL

KIND OF VEHICLE

P - PASSENGER M - MOTORCYCLE

T - TRUCK C - TRICYCLE

D - TRAILER R - REC. VEHICLE

B - BUS A - ATV ®

®

®

G - GASD - DIESELE - ELECTRIC

B - BEYOND LOCALL - LOCAL S - SHUTTLEF - FARM T - TRANSIT

GVWR OVER 16,000 LBS

YES

GR. WT. OR SEATINGCAPACITY NEW USED

(MSO) (TITLE)

K.O.V. CYL. H.P. TAB NUMBER EXP. MO. EXP. YR. SPECIALP

SURRENDERED TITLE NO. STATE ZONE

TRADE-IN

LICENSE TRANSFER

OTHER CREDIT

1 2

FEES

SIGNATURE OF ONE OWNER REQUIRED

FOR OFFICE USE ONLY

If this motor vehicle is registered at the time application for title is made, my signature shall certify that I have and will maintain, during the period of registration, financial responsibility with respect to each motor vehicle that I own, license, or operate on the streets or highways.

You must present your insurance card or other acceptable proof of financial responsibility.

Any false affidavit is a crime under Section 575.050 of Missouri law.

MO DEALER NUMBER DEALERSHIP NAME CITY, STATE, ZIP CODE TELEPHONE NUMBER

( )

“I CERTIFY UNDER PENALTY OF PERJURY THAT THE FACTS HEREIN ARE TRUE TO THE BEST OF MY KNOWLEDGE.”

SIGNATURE OF DEALER OR REPRESENTATIVE TRADE-IN

YES NO

DUPLICATE TITLE ONLY - COMPLETE REASON AND NOTARIZE. NOTARY INFORMATION APPLIES TO APPLICANT’S SIGNATURE.

LOST STOLEN MUTILATED (ATTACH MUTILATED TITLE) NEVER RECEIVED - LOST IN MAIL

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)

FIRST LIEN SECOND LIEN/MAIL TO SECURITY AGREEMENT DATE

FIRST LIEN SECURITY AGREEMENT DATE

YES NO

LIENHOLDER’S PHONE NO. SECOND LIEN

( ) YES NO

MAIL TO LIENHOLDER MAIL TO ALTERNATE ADDRESS BELOW. DO NOT USE IF SECOND LIEN OR SUBJECT TO FUTURE ADVANCES.

STFA

FHVUTWGT. OF PLATES FORM 2290

DIST. AMT.

$

SITE CODE

MILEAGE DATE

SURRENDERED PLATE NUMBER

SURRENDERED PLATE CREDIT

PROCESSED BY

APPROVE REJECT

DONATIONS $1 BLIND FUND $1 ORGAN FUND

$10 WW II MEMORIAL FUND

TOD BENEFICIARIES, IF APPLICABLE

COUNTY FLEET NUMBER L/R NUMBER

IN CITY LIMITS OUTSIDE CITY TELEPHONE NUMBER LIMITS ( )

DLN OR FEIN NUMBER

$

®

®

CHECK BOX IF PLATE DOES NOT EXPIRE

(B)

IF EXEMPT FROM STATE OR LOCAL TAXES, ENTER

EXEMPTION CODE HERE:

OWNER’S NAME - LAST, FIRST, MIDDLE (ONLY FIRST 50 POSITIONS WILL PRINT ON TITLE) INCLUDING TOD

STREET ADDRESS (MUST BE A PHYSICAL ADDRESS - CANNOT BE A PO BOX OR RURAL ROUTE)

CITY STATE ZIP CODE

E-MAIL

DATE

L=LP - PROPANE N - NATURALO - OTHER

PP INS

FEIN

SAFETY

EMISSION

Y E

Y E

PURCHASE DATE

PRICE

LICENSE FEE

$

RESERVATION FEE

$

ADDITIONAL HP/DR/DRX

$

TRANSFER FEE

$

FAILURE TO TRANS/RENEW

$

RENEWAL PENALTY

$

TITLE PENALTY

$

FUND DONATIONS

$

TITLE/QUICK FEE

$

STATE TAX

$

LOCAL TAX

$

SUBTOTAL

$PROCESSING OR AGENT FEE

$NOL PROCESSING FEE

$

TOTAL

$