General Affidavit: Reset Form

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768 General Affidavit
r The motor vehicle described on the attached application has not been operated on public roads or the highways of Missouri by
myself, or my agent during the period of __ __ /__ __ /__ __ __ __ to __ __ /__ __ /__ __ __ __. (*Notarization required)
r I am giving the unit described below to ____________________________________________________ and there is no money or other
valuable consideration involved in the transaction. (Note: in this instance, this completed affidavit should be given to the new owner along
with the assigned title. To notify the Department of Revenue that a transfer of ownership has occurred for a motor vehicle, trailer, all-terrain
vehicle (ATV), motorcycle, motortricycle, or autocycle, complete the tear-off Notice of Sale or Transfer (DOR-5049A) attached to the bottom
of the Missouri title or a Notice of Sale or Transfer (Form 5049) and submit the completed form to the address indicated on the form. The
original owner and the new owner are required to sign the Notice of Sale or Transfer form, even when gifting a motor vehicle, trailer, ATV,
motorcycle, motortricycle, or autocycle.)
r The motor vehicle described below has not been in the state of Missouri for the 60 day period immediately preceding the date of this
application for registration and will be submitted for inspection at an official inspection station within 10 days after entering the state
by myself, or my agent.
r The abandoned property described below was abandoned on real estate owned or purchased by me located at (address, city, state, zip
Certification
code): _____________________________________________________________________________________________________
and has an approximate retail and or fair market value of $ __________________. Provide a detailed explanation as to the circumstances by
which the real estate owner came into possession of the abandoned property and why the real estate owner considers the unit has been
abandoned: __________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
r I certify that I am seventy-five years old or older and am no longer required to present a physician’s statement at the time of renewal
for disabled person placards or license plates.
r Firefighter Plates - I certify and affirm that I am a director of a fire protection district, or are compensated, partially compensated,
or a volunteer member of a fire department, fire protection district, or voluntary fire protection association in Missouri. I further affirm
that if I resign, are removed, or otherwise terminate my association with the fire department, I will return my special license plates
to the Missouri Department of Revenue within 15 days. (*Notarization required)
Name of Fire District ____________________________________________________________________________________
r Other _______________________________________________________________________________________________________
____________________________________________________________________________________________________________
Any false statement in this affidavit is a violation of law, and may be punished by fine, imprisonment, or both.
Owner Year Make Model
Vehicle Identification Number Original Title Number Current License Number
Signature of Owner Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __
Embosser or black ink rubber stamp seal Subscribed and sworn before me, this
day of year
Notary Information
State County (or City of St. Louis) My Commission Expires (MM/DD/YYYY)
__ __ /__ __ /__ __ __ __
Notary Public Signature
Notary Public Name (Typed or Printed)
*License Office notary service - $2.00

Form 768 (Revised 05-2020)
Motor Vehicle Bureau Phone: (573) 526-3669 Visit http://dor.mo.gov/motorv/

E-mail: [email protected] for additional information.

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768 General Affidavit

Name of Fire District ____________________________________________________________________________________

Vehicle Identification Number Original Title Number Current License Number

Signature of Owner Date (MM/DD/YYYY)

State County (or City of St. Louis) My Commission Expires (MM/DD/YYYY)

Notary Public Name (Typed or Printed)

*License Office notary service - $2.00

Motor Vehicle Bureau Phone: (573) 526-3669 Visit http://dor.mo.gov/motorv/

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