Missouri Form 1062 PDF Details

Are you a business based in Missouri? Then it’s important for you to know about the requirements surrounding Missouri Form 1062. This form serves as an annual income statement that is required to be filed with law enforcement by entities within the state of Missouri before they can receive or transfer money, such as gambling winnings and lottery payments. In this blog post, we will break down what exactly businesses need to know about filing their Form 1062 and how its submission can help to protect your business from possible penalties and financial troubles.

Form NameMissouri Form 1062
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesAFFIX, TITLING, DOR-1062, lienholder

Form Preview Example


Missouri Department of Revenue


Affidavit for Mechanic Lien Title

Owner Information

All Lienholders Information

I certify that the motor vehicle, trailer, all-terrain vehicle, manufactured home, vessel, or outboard motor listed below is in my possession and that the owner of said unit has defaulted in payment. The total amount of repair and storage that is noted below has not been paid as evidenced by the attached work order or storage bill. The owner and lienholder listed below were notified of this debt by certified mail on the date noted. Copies of the notification letter(s) and the certified mail card(s) have been submitted with this affidavit. Neither the owner nor the lienholder has paid, or made satisfactory arrangements for payment of, storage or service towing charges within 30 days since notification of my intent to title the unit. See requirements on reverse.





Vehicle or Manufacturer’s Identification Number













Amount of Repair or Storage


__ __ __ __



















































































Titled Owner’s Name














Number of Months Payment Overdue (minimum of 45 days)

































Owner’s Address























Zip Code
































Name of Vehicle Owner’s Lienholder

Street Address




Zip Code






Name of Mechanic or Garage










Street Address




Zip Code






Date Owner Notified by Certified Mail (MM/DD/YYYY)

Signature of Applicant



__ __ /__ __/__ __ __ __

Notary Information

Embosser or black ink rubber stamp seal.

Subscribed and sworn before me, this




day of










County (or City of St. Louis)

My Commission Expires







Notary Public Signature









Notary Public Name (Typed or Printed)







Have you included: r Completed application

rCompleted affidavit

rSigned work order, storage agreement, or tow agreement

rSigned certified mail notification or unclaimed returned envelope

rTitling fees and processing fees

Form-1062 (Revised 06-2013)

Mechanic Lien Titles

In order to apply for a mechanic lien title for a motor vehicle, trailer, all-terrain, manufactured home, vessel or outboard motor, you must submit the following:

1.A completed and signed application for Missouri Title and License, DOR-108 (for motor vehicles, trailers, all-terrain vehicles and manufactured homes), or a completed and signed Application for Missouri Boat, Vessel, or Outboard Motor Title and Registration, DOR-93 (for vessels or outboard motors). For type of title, record “mechanic lien.”

2.The original or a copy of the written request for labor, services, skill, materials or storage costs signed by the owner, his agent, or at the written request of a peace officer in lieu of the owner or owner’s agent, where such owner or agent is not available to request storage, with the maximum amount to be charged as stated.

3.A notarized affidavit from the holder of the property certifying that the owner has defaulted on payment of labor, services, skill, or materials and that payment is 45 days past due, or that the owner has defaulted on payment, or has failed to make satisfactory arrangements for continued storage of the chattel for 30 days since notification by mail of intent to title.

4.A statement showing the outstanding balance for all labor, services, skills, materials or storage costs accumulated up to the date of application for title.

5.A check for $12.50 made payable to the Missouri Department of Revenue. The Missouri Department of Revenue may electronically resubmit checks returned for insufficient or uncollected funds.

Note: All requests for mechanic lien titles will be held for the 30 day notification period as required by law.



Form-1062 (Revised 06-2013)

Mail to: Motor Vehicle Bureau

Phone: (573) 526-3669

Visit dor.mo.gov

P.O. Box 2076

Fax: (573) 751-5209

for additional information.

Jefferson City, MO 65105-2076

E-mail: mvbmail@dor.mo.gov


How to Edit Missouri Form 1062 Online for Free

When working in the online PDF tool by FormsPal, you can fill out or edit DOR-1062 right here and now. FormsPal expert team is continuously endeavoring to enhance the tool and help it become much better for people with its many functions. Bring your experience to a higher level with continually improving and amazing opportunities we offer! To get the process started, go through these easy steps:

Step 1: Click the "Get Form" button in the top area of this webpage to open our editor.

Step 2: After you open the tool, you'll notice the document prepared to be filled in. Besides filling out different blanks, it's also possible to perform many other actions with the Document, namely adding custom text, changing the original textual content, inserting graphics, affixing your signature to the form, and much more.

So as to finalize this PDF form, ensure you provide the required information in each and every blank:

1. For starters, when filling in the DOR-1062, begin with the section that has the subsequent fields:

Filling out segment 1 of DOR-108

2. Just after completing this section, head on to the next part and fill in the necessary details in all these blank fields - n o i t a m r o f n, I y r a t o N, Notary Public Signature, Notary Public Name Typed or Printed, Have you included r Completed, r Completed affidavit r Signed, and Form Revised.

Stage no. 2 for completing DOR-108

It is easy to make errors while completing the Notary Public Signature, therefore make sure you go through it again before you decide to send it in.

Step 3: Before moving on, it's a good idea to ensure that all form fields have been filled out properly. When you think it is all good, click on “Done." Grab the DOR-1062 the instant you register here for a free trial. Quickly get access to the pdf document inside your FormsPal cabinet, with any modifications and adjustments being all saved! FormsPal is committed to the confidentiality of all our users; we make sure that all personal data coming through our system remains protected.