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Missouri Department of Revenue |
FORM |
Application for Missouri Historic or |
570 |
Personalized Historic License Plates |
Any false statement in this application is a violation of the law and may be punished by fine or imprisonment or both.
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Owner’s Name (as shown on the title) |
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DLN/FEIN Number |
Information |
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Street Address or R.F.D. |
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County |
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City, State, Zip Code |
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(__ __ __)__ __ __-__ __ __ __ |
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Telephone Number |
Owner |
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Year |
Make |
Vehicle Identification Number |
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Title Number |
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Body Style |
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Kind of Vehicle |
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r Historic (Fee - $25.25 Permanent Registration and a $3.50 Processing Fee)
Type of License Plate to be Issued (select one)
r Personalized Historic (Fee - $15.00 Personalized Fee in addition to the $25.25 Permanent Registration Fee and a $3.50 Processing Fee) If you currently have a historic plate on the above vehicle, the $25.25 is not due. Please indicate your current license number in the Historic License Number area. If the requested configuration is already issued for a vehicle you own, the plates must be surrendered with this application.
r Year of Manufacture (Fee - $25.25 Permanent Registration and a $3.50 Processing Fee) If you possess a license plate issued by the state of Missouri that is over 25 years old in which the year of the issuance of such plate is consistent with the model year of the vehicle, you may register the plate as a historic vehicle plate. Submit a picture of the plate with this application.
Year of Manufacture Plate Number |
Year That Appears on Plate (original expiration) |
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See reverse side for instructions on selecting your personalized license plate. Please use all capital letters and show choices in order of preference. Personalized license plates may consist of no more than six characters or six characters plus a dash, space, or an apostrophe. A personalized motorcycle license plate may consist of no more than six characters or five characters plus a space, dash, or apostrophe.
I hereby make application for the following personalized license plate to be issued to the above named owner(s).
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First Choice |
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Second Choice |
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Third Choice |
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Fourth Choice |
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Fifth Choice |
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Sixth Choice |
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Description of what the |
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Description of what the |
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Description of what the |
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Description of what the |
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Description of what the |
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Description of what the |
configuration above stands for. |
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configuration above stands for. |
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configuration above stands for. |
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configuration above stands for. |
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configuration above stands for. |
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configuration above stands for. |
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If your choice(s) for a personalized historic or year of manufacture license plate is not available, your application will be rejected and returned to you and your fees will be retained and applied to your corrected application when it is returned unless you specifically request a refund of your fees. If your choice for a personalized license plate is available, you will receive your license plates in approximately four to six weeks.
Financial Responsibility and |
Signature Required |
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Office |
Use |
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You must present your insurance card (a copy is acceptable) or other acceptable proof of financial responsibility with this application. Any false affidavit is a crime under Section 575.050 of Missouri law. The signature below shall certify that I have and will maintain, during the period of registration, financial responsibility with respect to each motor vehicle that I own, license, or operate on the streets or highways. I hereby affirm that the statements herein are true, that this vehicle is over 25 years old, is owned solely as a collector’s item, and will be used for exhibition and educational purposes.
Printed Name of Owner |
Date (MM/DD/YYYY) |
__ __ /__ __ /__ __ __ __
Signature of Owner
r Personal Property Tax Receipt r Insurance Verified By _________________________________________________________
Form 570 (Revised 06-2013)
Historic vehicles may be driven to and from events, to repair facilities within a 100-mile limit, and may be driven up to 1,000 miles per year for personal use. The owner of the historic vehicle shall be responsible for keeping a log of the miles driven for personal use each calendar year. Such log must be kept in the historic vehicle when the vehicle is driven on any state road.
A Historic Vehicle Log, Form-4012, can be downloaded from the following web site: http://www.dor.mo.gov/mvdl/motorv/forms/4012.pdf.
This permanent registration is not transferrable. If the vehicle is disposed of, historic license plates must be returned to the Director of Revenue for cancellation.
Disabled Person Plates (applies to personalized historic only): An original signed Physician’s Statement for Disabled Person’s License Plates (Form-1776) from an advance practice registered nurse, licensed physician, chiropractor, physician’s assistant, podiatrist, or optometrist must be submitted that states the disability is permanent. The physician’s statement is valid for 90 days after
completion by an authorized medical professional.
License plates will be issued only to those vehicles that are titled and registered in Missouri.
Instructions for Regular Historic License Plates
Application must be completed (record the owner’s name as shown on the title), signed, and submitted with the following:
•$25.25 permanent registration fee and a $3.50 processing fee;
•Personal property tax receipt or non-assessment statement from the previous year;
•Proof of current insurance which includes year, make, vehicle identification number, and expiration date; and
•Copy of title or copy of receipt of application for title.
Additional Instructions for Personalized Historic License Plates
Please submit a $15.00 annual fee for personalized historic license plates, which is required in addition to the requirements listed above, and is payable every year upon reapplication.
If you currently have historic plates on the vehicle referenced on the front of this application, the $25.25 permanent registration fee is not due. Please indicate your current historic plate in the Historic License Number area on the front of the application.
A personalized license plate may consist of no more than six characters plus a dash, space, or apostrophe. A personalized motorcycle license plate may consist of no more than six characters or five characters plus a space, dash, or apostrophe.
Please print capital letters and numbers as follows:
The Missouri Department of Revenue will not issue plates that contain any letters, numbers, or a combination of letters and numbers which are obscene, profane, patently offensive or contemptuous of a racial or ethnic group, offensive to good taste or decency, or would present an unreasonable danger to the health or safety of the applicant, of other users of streets and highways, or of the public in any location where the vehicle with such plate may be found. The Missouri Department of Revenue will not issue plates that conlict with the regular license numbering system.
Additional Instructions for Year of Manufacture License Plates
The owner of any historic vehicle possessing a license plate issued by the state of Missouri that is over 25 years old in which the year of issuance of such plate is consistent with the year of manufacture of the vehicle may register such plate as a historic vehicle plate as set forth in 301.131, RSMo, provided the plate coniguration does not conlict with the current numbering system. If you are in possession of a plate that is consistent with the year of manufacture of the vehicle, please submit a picture of the plate that clearly shows the plate number and year with this application and the requirements listed above. If you have any questions, please contact the Motor Vehicle Bureau at (573) 526-3669.
Example: A 1965 vehicle can be registered using a Missouri license plate from 1965.
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Form 570 (Revised 06-2013) |
Mail to: Motor Vehicle Bureau |
Phone: (573) 526-3669 |
Visit dor.mo.gov |
P.O. Box 569 |
Fax: (573) 751-5209 |
for additional information. |
Jefferson City, MO 65105-0569 |
E-mail: mvbmail@dor.mo.gov |
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