The Missouri 5177 form is a Title Assignment Correction Form used by the Missouri Department of Revenue. This form helps correct any incomplete information on a vehicle's title or certificate of ownership. Ensuring that this form is filled out accurately is essential for a smooth vehicle transfer process.
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The Missouri 5177 form, officially titled the Title Assignment Correction Form, serves a crucial role in the vehicle ownership transfer process within the state. Designed for use by both buyers and sellers, this form addresses situations where the original vehicle title contains incomplete or incorrect information. It is essential for ensuring that all pertinent details—such as the vehicle identification number, odometer reading, and sale price—are accurately recorded. The form requires signatures from both the purchaser and the seller, affirming the validity of the information provided. Additionally, it includes an acknowledgment section where individuals declare under penalty of perjury that the details filled in are true and complete. This form must be submitted to the Missouri Department of Revenue Motor Vehicle Bureau, ensuring compliance with state regulations outlined in Chapter 301 of the Revised Statutes of Missouri. Proper completion and submission of the Missouri 5177 form facilitate a smooth transition of ownership and help prevent potential disputes or complications in the future.
MISSOURI DEPARTMENT OF REVENUE MOTOR VEHICLE BUREAU
P.O. BOX 3111
JEFFERSON CITY, MO 65109
TITLE ASSIGNMENT CORRECTION FORM
FORM
5177
(REV. 7-2011)
The Missouri Department of Revenue certifies that the record attached hereto is an exact duplicate of the original title/certificate of ownership lawfully filed or deposited with the Department pursuant to Chapter 301 RSMo for the unit listed below:
Year __ __ __ __ Make _______________________________________
Vehicle Identification Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
The attached document contains incomplete information. Please record the information listed below in the assignment area of this form. Make sure this form is signed and dated and then return to the Department of Revenue at the above address.
Purchaser(s) Name ____________________________________________________________________
Purchaser(s) Address ___________________________________________________________________
Odometer reading (No Tenths) at the time of purchase* __________________________________________
Signature of all Purchaser(s) ______________________________________
Date _________________________
Signature of all Seller(s) _________________________________________
Sale Price ___________________________________________
*Sellers signature required when mileage is needed at the time of purchase.
Date of Sale ________________________
ACKNOWLEDGEMENT - SIGNATURE REQUIRED
I hereby declare under penalties of perjury, that I have completed the missing information on the form or had the seller complete the information as required by law. By signing below, I certify that the information listed is true, accurate, and complete to the best of my knowledge and belief.
BUSINESS NAME (PRINT COMPLETE NAME) ___________________________________________________________________________________
APPLICANT/BUYER OR AUTHORIZED AGENT’S PRINTED NAME AND POSITION _____________________________________________
APPLICANT/BUYER OR AUTHORIZED AGENT’S SIGNATURE ______________________________
DATE __________________________
SELLER’S PRINTED NAME _______________________________________________________________________
SELLER’S SIGNATURE ______________________________________________________
DOR-5177 (7-2011)
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