Form 4669 Missouri – Fill Out and Use This PDF

Owner, Lessee, Property	Must Complete
A — Private Property	or Security Manager
Section

Section B — Towing Company Must Complete
— Law Enforcement Agency	Must Complete
Section C

I authorize the vehicle to be towed based on the reason indicated below. Select a reason:

r 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. I will notify the law enforcement agency within one hour of the tow.

r2. 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.

r3. 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.

I certify that the vehicle listed below was abandoned on property of which I am the owner, lessee, or property or security manager. This form is for tows from private property not authorized by law enforcement. I have authorized the towing company listed below to remove the vehicle from my property and witnessed the removal of the vehicle. I further certify that all information contained herein is true and accurate to the best of my knowledge. I understand this is a legal declaration subject to criminal penalties.

Signature of Owner, Lessee, Property or Security Manager	Phone Number of Owner, Lessee, Property
	or Security Manager (___ ___ ___) ___ ___ ___ - ___ ___ ___ ___
Printed Name of Owner, Lessee, or Property Security Manager	Date of Tow (MM/DD/YYYY)
	___ ___ / ___ ___ / ___ ___ ___ ___

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

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

Towing Company Phone Number

to DOR Records

r Yes

r No

(___ ___ ___) ___ ___ ___ - ___ ___ ___ ___

Address of Towing Company

City

State

Zip Code

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

Signature of Towing Operator	Printed Name of Towing Operator

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

Law Enforcement Agency

Date Notified of Tow (MM/DD/YYYY)

Date Report Filed (MM/DD/YYYY)

___ ___ / ___ ___ / ___ ___ ___ ___

___ ___ / ___ ___ / ___ ___ ___ ___

Inquiry Date (MM/DD/YYYY)

r

NCIC (Provide Number) ___________________

r

MULES

r

REJIS

r

Other

___ ___ / ___ ___ / ___ ___ ___ ___

MSHP Number

Report, Case, Incident, Tow Number

Abandoned Property Owner’s Name

Address

City

State

Zip Code

Lienholder’s Name

Address

City

State

Zip Code

Signature of Officer

Printed Name of Officer

Badge

Abandoned Property Report Instructions

•Owner, lessee, property, or security manager completes and signs this form;

•Towing company completes, signs, and delivers this report to the law enforcement agency within two hours of the tow if reason one is checked on front or within twenty-four hours for all other tows;

•Law enforcement officer completes and signs this form and retains a copy for their files;

•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;

•Towing company retains their copy of the Form 4669 for three years;

•Towing company must notify the Department in writing of any address change;

•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 below for further research.

Motor Vehicle Bureau, Record Center PO Box 2048

Jefferson City MO 65105-2048

•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). A Department search will be done by:

1)Searching the Department files; or

2)Initiating an inquiry with another state if the evidence presented indicates the abandoned property was registered or titled in another state.

•The Department will send a notification letter to the towing company within 15 working days after the search is completed with the following information:

1)The name and address of the owner and lienholder; or

2)Instructions if there is no record information available (please see below).

•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.

No Information Found on	Record Notification Received

Apply for Original, Salvage, or	Abandoned Property Titles
How to	Junk

If the Department has no record of the abandoned property, the towing company must certify that a physical search of the abandoned property disclosed no other evidence of ownership. The towing company must also certify that a good faith effort was made to establish the prior state of registration and title by checking the items below:

1)The abandoned property for any type of license plates, license plate record, temporary permit, inspection sticker, decal, or other evidence that may indicate a state of possible registration and title;

2)The tow ticket or report of the tow operator to see if a license plate was on the abandoned property at the beginning of the tow, if a private tow; and

3)The tow ticket or report of the tow operator to see if any information is indicated for the Driver, Owner, or Lienholder of the vehicle.

Note: The Department will provide the tower with a notification letter to certify the above checks have been made. This certification must accompany the application for title.

Send all title applications on abandoned property to the address below.

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, sales tax or processing fees.);

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 above);

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)A completed and signed Vehicle Examination Certificate (Form 551), if applying for an “Original” title (contact the nearest Highway Patrol Headquarters for vehicle inspection); and

7)Abandoned Property Report (Form 4669) completed by owner, lessee, property or security manager, tow company, and local law enforcement agency.

Important: Mileage must be shown on the application for title for vehicles model year 2011 and newer until the vehicle reaches the age of twenty years old. If the mileage is unobtainable, write in an estimated mileage and a statement at the bottom of the application that mileage is only estimated. Complete and attach an odometer disclosure statement (Form 3019) and include the reason for mileage estimate: fire, digital dash inoperable, or other. This must accompany the application for title.

Form 4669 (Revised 01-2021)