Subscribed and sworn before me, this
day of year
State County (or City of St. Louis) My Commission Expires (MM/DD/YYYY)
Notary Public Signature
Notary Public Name (Typed or Printed)
Embosser or black ink rubber stamp seal
__ __ /__ __ /__ __ __ __
Notary Information
Section 304.156, RSMo, provides that thirty (30) days after a notification form has been mailed to the abandoned property owner
and lienholder, if applicable, and the property is unredeemed and no satisfactory arrangement has been made with the lienholder in
possession for continued storage, and the owner or lienholder, if applicable, has not requested a hearing as provided, the lienholder
in possession may apply to the Director of Revenue for an original title, salvage certificate of title designated with the words “Salvage
or Abandoned Property” or junking certificate based on the condition of the abandoned property. This affidavit must be included with
the application for title. See checklist on reverse for other requirements.
Abandoned Property Towed
Year Make Model Vehicle, Vessel, Outboard Motor Identification Number
Owner Lienholder
Street Address Street Address
City State Zip City State Zip
On __ __ / __ __ / __ __ __ __
, I towed the above mentioned property. I have been in possession of the abandoned property
for at least 30 days and the owner of the abandoned property or lienholder have not made arrangements for payment of towing
and storage charges. I have not been notified of any application for hearing as provided in Section 304.156, RSMo.
If notice to the owner and lienholder of the abandoned property has been returned “Not Forwardable” or “Addressee Unknown,”
my signature on this affidavit certifies that a physical search of the abandoned property disclosed no other evidence of
ownership and that a good faith effort has been performed to establish the prior state of registration and title. The following
was searched, if applicable:
1. The abandoned property for any type of license plates, license plate record, temporary permit, inspection sticker, decal,
or other evidence which may indicate a possible registration and title in another state;
2. The law enforcement report for a license plate number or registration number if the abandoned property was towed at
the request of a law enforcement agency;
3. The tow ticket or report of the tow truck operator to see if a license plate was on the abandoned property at the
beginning of the tow, if a private tow; and
4. The law enforcement report to see if an out-of-state address is indicated on the driver license information if there is no
address of the owner on the impound report.
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
Towing Company Name Signature of Tower Date (MM/DD/YYYY)
__ __ /__ __ /__ __ __ __
Signature
Visit
http://dor.mo.gov/forms/Abandoned_Vehicle_Manual.pdf
for additional information.
Form 4576 (Revised 08-2019)
This form must be attached to your motor vehicle registration application.
Motor Vehicle Bureau Phone:
301 West High Street – Room 370 (573) 526-3669
Jefferson City, MO 65101
Form
4576
Abandoned Property Affidavit
Note: License Ofce notary service - $2.00
