Form 1576 – Fill Out and Use This PDF

Form	Application for Replacement
1576	Plate(s) and Tab(s)

Office Validation

Owner	Information
Vehicle Information
Replacement Plate	Information

Signature

Notary Information

Office Use Only

Owner’s Name (Last, First, Middle)

Telephone Number

(__ __ __) __ __ __ - __ __ __ __

Street, Rural Route, or P.O. Box

City

State

Zip Code

County

Year

Make

Vehicle Identification Number

|

|

|

|

|

|

|

|

|

|

|

|

|

|

|

|

Title Number

Body Style

Kind of Vehicle - If Truck or Bus

License Number

Tab Number

New Tab Number

(Zone, Gr.Wt., Seat)

Expiration Month

Expiration Year

Replacement Permit Number

Total Fees

Do not use this form if plates are being issued from stock. Use an Application for License (Form 184) instead.

Number of Plates Needed r One

r Two

r Tabs Only

r Bronze Star Placard

r Change of Address

Reason Required r Lost r Stolen

r Mutilated

r Destroyed

r Never Received

r Seized by Law Enforcement

r Second Plate Only (see reverse)

No notarization required

Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.

Signature

Title

Printed Name

Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __

Embosser or black ink rubber stamp seal

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)

Applicant last renewed this registration on __ __ /__ __ /__ __ __ __ at the _____________________________________________ office.

Applicant presented documented proof that the above vehicle is currently registered and the registration is current for this period as witnessed by ___________________________________________________________________________________________________.

Agent’s Signature

Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __

Remarks

Applicant Instructions - Please Read Carefully

Replacement Plate(s) and Tab(s) - Special Instructions

Vehicle owners can obtain replacement plate(s) or tab(s) in instances when the original has been lost, stolen, mutilated, destroyed, or never received.

Refer to warning at the top of form. (301.420 RSMo)

•Ensure replacement plate(s) or tab(s) are necessary. Refunds will not be granted after the manufacture of replacement plates.

•If the original is found after application is made, the original becomes null and void and must be surrendered immediately to the Missouri Department of Revenue.

1.Your name must match the name as it appears on your certificate of title or registration receipt or this application will be rejected.

2.Enter your current address and telephone number where you may be reached during normal business hours.

3.Complete all vehicle information blocks.

4.For truck or bus plates, enter zone and weight or seating capacity.

5.Enter current license plate(s) or tab(s) number and expiration month and year.

6.If applying for replacement plates or tabs, indicate the number of plate(s) you need to replace. If replacing tabs only, mark the “Tabs Only” block.

7.Indicate the reason required.

8.The application must be signed in the presence of a Notary Public. NOTE: A notary is not required if applying for an optional second plate Commercial Motor Vehicle (CMV).

When application is made for replacement plate(s), you will be issued one Replacement Plate Permit. This permit serves as proof of valid registration until you receive the replacement plate(s). The permit is to be displayed on the back windshield of your motor vehicle unless it is an autocycle, motorcycle, motortricycle, or trailer. Please carry the validated application receipt with you as proof of valid registration until you receive your replacement plate(s) or tab(s).

If only one plate is replaced, it must be attached to the rear of the vehicle. A replacement plate for a CMV must be attached to the front of the vehicle.

		TABS	EMBOSSED PLATES		FLAT PLATES		SPECIALTY
	FEE TYPES						PERSONALIZED
		Per Tab or Set	Per Plate	Per Set	Per Plate	Per Set
							and STOCK PLATES
	Replacement	$8.50	$8.50	$17.00	$8.50	$17.00	$8.50
	Processing	$6.00	$6.00	$6.00	$6.00	$6.00	$6.00
	Reissuance	N/A	$1.68	$3.36	$3.77	$7.54	$0 (EXEMPT)

Any person replacing stolen license plates or tabs may receive up to two sets of license plates or tabs per year at no cost,

a processing fee will still apply.

Second Plate Only - Any owner of a commercial motor vehicle whose vehicle is licensed as farm, local or beyond local in excess of 12,000 lbs., or an owner of a commercial bus may be issued a second license plate. The second license plate will bear the same configuration as the initial license plate and contain a number “2” sticker in the upper right hand corner. The first plate must be attached to the front of the vehicle and the second plate, with the “2” sticker, must be placed on the rear of the vehicle. No notarization is required for optional second plate CMV.

	FEE TYPES	EMBOSSED PLATES	FLAT PLATES	SPECIALTY PERSONALIZED
				and STOCK PLATES
	Second Plate	$8.50	$8.50	$8.50
	Processing	$6.00	$6.00	$6.00
	Reissuance	$1.68	$3.36	$0 (EXEMPT)

Note: License Office notary service - $2.00

All payments by check must:

1.Be payable to Missouri Department of Revenue.

2.Be pre-printed with the check writer’s name, address, bank code, and account number.

3.Include the check writer’s driver license or nondriver license number, date of birth, and daytime telephone number.

Note: The Missouri Department of Revenue may electronically resubmit checks returned for insufficient or uncollected funds. Other restrictions may apply.