Form 4669 Missouri – Fill Out and Use This PDF

Select a reason. 1. A sign not less than 17 x 22 inches in size containing lettering not less than one inch in height is displayed within plain view prohibiting public parking and indicating that unauthorized abandoned property or property parked in a restricted or assigned area will be removed at the owner's expense, disclosing the maximum fee for all charges related to towing and storage. I will notify the law enforcement agency within one hour of the tow.

2. The abandoned property was left unattended on owner-occupied residential property with four units or less. I have notified the law enforcement agency and ten hours have elapsed since that notification.

3. The abandoned property was left unattended on private property. I have notified the law enforcement agency and ninety-six hours have elapsed since that notification.

This form is for tows from private property not authorized by law enforcement. You have authorized the towing company to remove the vehicle from your property and witnessed the removal of the vehicle. You further certify that all information contained herein is true and accurate to the best of your knowledge. You understand this is a legal declaration subject to criminal penalties. You certify that the vehicle was abandoned on property of which you are the: Owner, Lessee, Property Manager, Security Manager.

Section A - Private Property Owner, Lessee, Property or Security Manager Must Complete: Signature, Phone Number, Printed Name, Time of Tow with AM or PM, Date of Tow (MM/DD/YYYY) and Location of Abandoned Property to be Towed (Street Address, City, State, and Zip Code).

Name and Address of the Abandoned Property or Driver Owner, If Known.

Name and Address of the Lienholder of the Abandoned Property, If Known.

Description of Damage to the Abandoned Property.

Year, Make, Model, Vehicle Identification Number, Mileage, Plate Number, State.

Section B - Towing Company Must Complete: Storage Location of the Abandoned Property.

Law Enforcement Agency Notified (Must be Same Agency in Section A), Date Notified (MM/DD/YYYY), Time Notified.

Law Enforcement Agency Address, City, Law Enforcement Agency Phone Number, Name of Towing Company, Tower Has Online Access to DOR Records (Yes or No), Towing Company Phone Number.

Address of Towing Company, City, State, Zip Code.

This report must be given to the law enforcement agency within two hours of the tow if reason 1 is checked or within twenty-four hours for all other tows.

Signature of Towing Operator, Printed Name of Towing Operator.

Section C - Law Enforcement Agency: Must be Completed by Law Enforcement Agency under Section 304.157, RSMo.

Towing companies with online record access must check Department records online for owner and lienholder information. If the towing company does not find owner or lienholder information using the online record check, the towing company, within ten days of the tow, must send a copy of the completed "No Record" screen from the online record search and the Form 4669 to the address listed at the bottom of page.

Towing company sends the original Form 4669 to the Missouri Department of Revenue (Department) if property remains unclaimed after ten days and the tow company does not have online access to Department records.

The Department will perform a record search for the name and address of the owner and lienholder of record within five working days of receipt of the Form 4669 submitted by tow company (no online access) or a completed "No Record" screen from the online record search and the Form 4669 submitted by the towing company (with online access). The Department will send a notification letter to the towing company within 15 working days after the search is completed with the name and address of the owner and lienholder, or instructions if there is no record information available.

Towing company must send a completed Vehicle Owner and Lienholder Notification (Form 4577) by certified mail, return receipt requested within ten days to the owner or lienholder as provided from the Department records.

Submit the following when applying for a title for an abandoned vehicle: 1) Application for title with appropriate fees, properly completed in the towing company's name. The title type must be marked "Original", "Salvage", or "Junking Certificate" (Tow company not required to pay title fee, or sales tax.); 2) Abandoned Property Affidavit (Form 4576) properly completed, signed by the tower, and notarized by a notary public; 3) A copy of the Vehicle Owner and Lienholder Notification (Form 4577) issued to any owner and lienholder of record. This must be sent by certified mail; 4) A copy of the certified mail return receipt(s) at least 30 days old, indicating all owners and lienholders of record, if applicable, have been sent Form 4577 (see 3); 5) A copy of the notification the Department of Revenue issued to the towing company or a copy of the "Record Lookup Results" screen from the online record search; 6) If applying for an "Original" title: A completed and signed Vehicle Examination Certificate (Form 551), (contact the nearest Highway Patrol Headquarters for vehicle inspection), If applying for "Salvage" or "Junking Certificate" and vehicle is model year 2011 or newer: A completed odometer disclosure statement (Form 3019). 7) Abandoned Property Report (Form 4669) completed by owner, lessee, property or security manager, tow company, and local law enforcement agency.

How to Apply for Original, Salvage, or Junk Abandoned Property Titles Mail to: Motor Vehicle Bureau P.O. Box 2076 Jefferson City, MO 65102-2076 Phone: (573) 526-3669 Visit dor.mo.gov/motor-vehicle/titling-abandoned-property/ for additional information.

Form 4669, the Abandoned Property Report, is for tows from private property not authorized by law enforcement.