The 5017 Missouri form serves as an official request for creating or updating an online account with the Missouri Department of Revenue, particularly for matters related to motor vehicles, such as notice of lien filing and records access through direct debit. Designed to streamline the process of handling vehicle liens and accessing records online, this form encapsulates sections ranging from new application enrollment to modifications or cancellation of existing account details. Interested parties are encouraged to accurately complete and submit the form to facilitate smooth transactions with the Missouri Department of Revenue. To effortlessly fill out the form, click the button below.
In this increasingly digital age, the Missouri Department of Revenue has streamlined processes to facilitate easier access to motor vehicle and marine records, as well as the efficient filing of Notices of Liens through an online account setup, as outlined in Form 5017. Aimed at a variety of users including banks, credit unions, individuals, and dealers acting as lienholders or filing for lienholders, this form represents a crucial step towards simplifying interactions with the government while maintaining the integrity and security of personal and business information. It meticulously guides applicants through a process starting from the type of application—new, change, or cancel—and delves into the specific transaction types requested, whether for online notice of lien filings or direct record access. Essential details regarding the business or individual applying, including the contact person's information and identification numbers, are covered in Section B, demonstrating the form's thorough approach to collecting necessary data. Additionally, Sections C and D address financial matters by requiring information about the applicant's financial institution and granting the Department of Revenue authorization for direct debits for payments related to the services accessed. Ensuring compliance with the Driver’s Privacy Protection Act, applicants are reminded of their liability for accuracy and the legal implications of their electronic transactions. Each step of the process, detailed on Form 5017, underscores the responsibilities and requirements, providing a comprehensive framework for accessing Missouri's online vehicle-related services.
MISSOURI DEPARTMENT OF REVENUE
MOTOR VEHICLE BUREAU
PO BOX 2167, JEFFERSON CITY MO 65105-2167
(573) 526-3669 http://dor.mo.gov/mvdl
APPLICATION FOR ONLINE ACCOUNT
(NOTICE OF LIEN FILING/RECORDS ACCESS/DIRECT DEBIT)
SECTION A - APPLICATION/TRANSACTION TYPE - CHECK APPROPRIATE BOXES
FORM
5017
(REV. 8-2012)
APPLICATION TYPE
NEW
CHANGE
CANCEL
TRANSACTION TYPE(S) REQUESTED
ONLINE NOTICE OF LIEN FILING
ONLINE RECORD ACCESS
SECTION B - BUSINESS AND CONTACT PERSON INFORMATION - PLEASE TYPE OR PRINT USING A BALL POINT PEN.
SEE INSTRUCTIONS ON REVERSE SIDE.
BUSINESS
CONTACT PERSON
NAME OF BUSINESS OR INDIVIDUAL
CONTACT PERSON’S NAME (LAST, FIRST, MIDDLE)
IDENTIFICATION NUMBER
CONTACT PERSON’S ADDRESS (STREET, RR, OR PO BOX NUMBER)
SEE INSTRUCTIONS ON BACK
BUSINESS OR INDIVIDUAL’S ADDRESS (STREET, RR, OR PO BOX NUMBER)
CITY
STATE
ZIP CODE
E-MAIL ADDRESS
TELEPHONE NUMBER
(
)
SECURITY ACCESS CODE (DPPA NUMBER) - COMPLETE IF APPLYING FOR ONLINE RECORD
TYPE OF BUSINESS
ACCESS.
BANK
TITLE LOAN
INDIVIDUAL
SAVINGS AND LOAN
CREDIT UNION
DEALER FILING AS LIENHOLDER
DEALER FILING FOR A LIENHOLDER
DEPARTMENT USE ONLY
TOWER (NO CHARGE FOR ONLINE RECORD ACCESS - DO NOT COMPLETE SECTION C OR SECTION D)
OTHER ___________________________________________________________________________________
SECTION C - ACCOUNT INFORMATION - COMPLETE ONLY IF NEW APPLICATION OR CHANGING ACCOUNT INFORMATION.
FINANCIAL INSTITUTION NAME
( )
FINANCIAL INSTITUTION ADDRESS (STREET, RR, OR PO BOX NUMBER)
ACCOUNT TYPE - CHECK ONLY ONE BOX
CHECKING
SAVINGS
GENERAL LEDGER
ROUTING NUMBER
DEPOSITOR (BUSINESS) ACCOUNT NUMBER
SECTION D - DIRECT DEBIT AUTHORIZATION - CHECK APPROPRIATE BOX.
A VOIDED CHECK OR DEPOSIT SLIP MUST BE ATTACHED.
I hereby authorize the Missouri Department of Revenue (Department) to initiate an electronic debit from the account identified above for payment of Notices of Liens processed and/or any records accessed online. I recognize that it is my responsibility to have the funds available in the account identified above for the withdrawal of my payment. I also understand that if the Department cannot deduct the payment from my account because funds are unavailable, I will be subject to overdraft fees from my financial institution. I will also be charged a dishonored payment penalty by the department. I further certify under penalties of perjury that I am authorized to sign this application and that any personal information obtained from any department records accessed will only be used as provided for in the federal Driver’s Privacy Protection Act.
I hereby cancel the authorization to electronically debit the account identified above.
SIGNATURE OF BUSINESS OWNER, PARTNER, CORPORATE OFFICER, OR INDIVIDUAL
PRINTED NAME OF BUSINESS OWNER, PARTNER, CORPORATE OFFICER, OR INDIVIDUAL TITLE OF BUSINESS OWNER, PARTNER, CORPORATE OFFICER, OR INDIVIDUAL
STAPLE VOIDED CHECK OR DEPOSIT SLIP HERE
DOR-5017 (8-2012)
PLEASE READ THIS INFORMATION CAREFULLY
COMPLETION INSTRUCTIONS
1.To apply for an online account to file Notices of Lien and/or access motor vehicle and marine records and have the payment for such transactions direct debited, complete this form as follows:
General Instructions
•Complete Sections A, B, C, and D if you are enrolling for the first time, re-enrolling after cancellation, changing your existing debit authorization, or other information. If you are a tower, do not complete Sections C and D when requesting online record access only.
•If you are cancelling your debit authorization, complete Sections A, B, and D only.
Section A - Application/Transaction Type
•Application Type - Check the appropriate box.
1.New - Complete for new enrollment or re-enrollment after cancellation.
2.Change - Complete to change type of account, financial institution or branch routing number, depositor (business) account number, or other information.
3.Cancel - Complete to cancel your debit authorization.
•Transaction Type(s) Requested - Check the appropriate box(es).
Section B - Business and Contact Person Information
•Complete all blocks for both the business or individual and contact person information.
•Security Access Code - This code is issued by the Motor Vehicle Bureau to entities who qualify under the Driver’s Privacy Protection Act to receive personal information contained in the department’s vehicle and marine records. If you indicate you would like online record access in Section A - Transaction Type(s) Requested, you must enter the Security Access Code. If you do not have a Security Access Code, you may apply by completing a Request for MV/DL Record(s)/Security Access Code (DOR-4678). The application can be obtained from any local contract office.
•Identification Number - Please record the FDIC number (bank), NCUA number (credit union), Dealer number (licensed motor vehicle/boat dealer), FEIN (any other type of business), or SSN (individual) as the identification number. The last six blocks are for Department of Revenue use only.
•Type of Business - Check the appropriate box.
Section C - Account Information
•Financial Institution Information - Record the financial institution’s name, telephone number, address, city, state, and zip code.
•Account Type - Check the appropriate box.
•Routing Number - Your financial institution’s routing number is printed on the bottom left-hand portion of your business or personal checks or deposit tickets (the first 9 digits). See examples 1 and 2 below.
•Depositor (Business) Account Number - Your depositor account number is printed on the bottom of your business or personal
checks following the routing number. It may be the first series of digits after the routing number followed by the check number
(example 1), or it may be the series of digits which follow the check number (example 2). NOTE: Check number is not included in the depositor account number.
Example 1
Example 2
XYZ BUSINESS
CHECK NO. 4444
CHECK NO.
HOMETOWN, USA
PAY TO THE ORDER OF ___________________________________
121456789
8765432109812
4444
R121456789
Routing No.
Dep. Acct. No.
Ck. No.
NOTE: Credit unions and savings and loan associations may differ from the above examples. Please verify your depositor account number and electronic routing number with your financial institution.
Section D - Direct Debit Authorization
•Check appropriate box. Attach a voided business or personal check or deposit slip to the front right-hand side of this application. This is necessary to verify the depositor account number, routing number, and financial institution.
2.Submit the completed application to the following address:
PO BOX 2167
JEFFERSON CITY MO 65105-2167
CHANGE FINANCIAL INSTITUTION OR DEPOSITOR ACCOUNT INFORMATION
Debits (withdrawals) will continue to be made from the designated account at your financial institution until the Missouri Department of Revenue is notified that you wish to redesignate your account and/or financial institution. To redesignate, complete and submit a new Application for Online Account (Notice of Lien Filing/Records Access/Direct Debit) with the new information.
After deciding to set up or modify your online account for lien filings or records access with the Missouri Department of Revenue, the 5017 form is the essential paperwork to start with. This process may seem a bit daunting at first, but by following a step-by-step guide, you can complete it accurately. Whether you're looking to file Notices of Lien, gain access to motor vehicle and marine records online, or set up direct debit for these services, it's important to ensure every part of the form is filled out correctly. Let's break down the steps needed to complete the form smoothly and efficiently.
Completing the form is just the beginning. Once submitted, your application will be reviewed by the Missouri Department of Revenue, and upon approval, you will receive confirmation and further instructions on how to use your online account. Remember, it's essential to keep a copy of your completed form and any correspondence for your records. This proactive step in managing your account ensures you're well-prepared for any online transactions related to Notices of Lien or record access. By following these steps carefully, you can navigate the process with confidence and ease.
Form 5017 is utilized by the Missouri Department of Revenue for individuals or businesses to apply for an online account. This account enables the filing of Notices of Lien and accessing motor vehicle and marine records. Additionally, it allows for the direct debit of payment for these transactions from the user's account.
Any business or individual needing to file Notices of Lien or access motor vehicle and marine records through the Missouri Department of Revenue’s online system must complete Form 5017. This includes banks, title loan companies, savings and loan associations, credit unions, dealers filing as lienholders, or dealers filing for a lienholder.
Completing Form 5017 involves several sections:
Towers requesting just online record access do not need to complete Sections C and D.
No, there is no charge for accessing records online. Sections C and D related to direct debit information do not need to be completed if access to online records is the only service required.
To cancel your direct debit authorization, you need to complete Sections A, B, and D of the form, indicating a cancelation in Section A, and submit it to the Motor Vehicle Bureau.
Once filled, the Form 5017 should be mailed to the MOTOR VEHICLE BUREAU, PO BOX 2167, JEFFERSON CITY MO 65105-2167.
If you wish to change the financial institution or account information, you must complete a new Form 5017 with the updated details and submit it to the provided address.
The routing number is located on the bottom left-hand portion of your checks or deposit slips, while your depositor account number can be found immediately following the routing number or after the check number, depending on the check layout. An attachment of a voided check or deposit slip is necessary for verification when applying for direct debit authorization.
If the Missouri Department of Revenue cannot deduct a payment due to insufficient funds, you will be responsible for any overdraft fees charged by your financial institution and a dishonored payment penalty by the department. It is crucial to ensure sufficient funds are available in your account to cover the transactions.
When filling out the Form 5017 for the Missouri Department of Revenue, it's crucial to pay close attention to details to ensure your application is processed smoothly. However, a few common mistakes can create bumps in the road. Understanding these pitfalls can help you avoid them:
By avoiding these common mistakes, you can facilitate a smoother interaction with the Missouri Department of Revenue's processes for managing your motor vehicle or marine records and lien filings. Paying close attention to detail and carefully reviewing the instructions and information you provide can save you time and potential headaches down the line.
When businesses or individuals in Missouri engage with the motor vehicle and marine records system, particularly for online account management like filing Notices of Liens or accessing records, they often need to submit the Form 5017 to the Missouri Department of Revenue. However, the process frequently requires additional documentation to either support the initial application, modify account details, or fulfill specific legal obligations. Understanding these supplementary documents can streamline interactions with the Department of Revenue and ensure compliance with state requirements.
Each of these documents plays a crucial role in the broader context of Missouri's motor vehicle and marine records management. By familiarizing themselves with these forms, businesses and individuals can ensure a smoother process, whether they’re establishing a new online account with the Department of Revenue, managing existing accounts, or navigating the complexities of lien filings and record access. Understanding the purpose of each document and when it’s required will help streamline any transaction with the Missouri Department of Revenue, ensuring compliance and facilitating the intended business or personal outcomes.
The 5017 Missouri form, designed for online account application for notice of lien filing, records access, and direct debit by the Missouri Department of Revenue, echoes the purposes and structure of several other vital documents within the realm of vehicle and financial transactions. Specifically, its parallels can be drawn with forms used across different states for lien filings and direct debit authorizations for tax and registration fees, and federal documents related to privacy and electronic debits.
Firstly, the Uniform Commercial Code (UCC) filing form, prevalent across various states, shares numerous functionalities with the Missouri 5017 form. The UCC form is a legal document filed by lenders to declare their rights to collateral or liens against a debtor's property, be it personal or business-related. Both the 5017 form and the UCC filing forms require detailed business and contact person information, a declaration of the transaction type (in the case of the UCC, often a new lien, amendment, or continuation), and specific details about the lien itself. Although the UCC form is more broadly applicable across different types of properties and not limited to motor vehicles, the core purpose of securing a public claim on assets is mutual.
Secondly, another analogous document is the IRS Form 9779, EFTPS Direct Debit Application. This form facilitates taxpayers in enrolling for direct debit for their taxes, very much akin to the direct debit authorization segment in Missouri's form 5017 for lien filings and record access payments. Both documents necessitate the provision of financial institution details, such as routing numbers and account numbers, to set up the direct debit service. Furthermore, they encompass consent clauses where the applicant authorizes the respective department (the IRS for Form 9779 and the Missouri Department of Revenue for Form 5017) to initiate electronic debits. The similarity bolsters the convenience and efficiency of processing financial transactions directly from one's bank account, mitigating the risks of late or missed payments.
Lastly, the 5017 Missouri form aligns with the Federal Driver’s Privacy Protection Act (DPPA) Request Form in terms of privacy concerns and permissions. The section of the 5017 form regarding the security access code for online record access is particularly reminiscent. Both forms are fundamentally concerned with the lawful request and use of personal information derived from motor vehicle records. They ensure that any access to or sharing of such information complies with federal privacy protection standards, outlining the specific circumstances under which the information may be used and requiring certification from the applicant that these conditions are understood and will be adhered to.
When filling out the 5017 Missouri form, there are several key practices you should follow to ensure your application process is seamless and correct. It's equally important to be aware of common mistakes to avoid. Below, find a compiled list of dos and don'ts to guide you through the process.
Only businesses can apply: A common misconception is that the Missouri Form 5017 is exclusively for businesses. In fact, both businesses and individuals can apply for access to online services, including notice of lien filing and records access, as specified in Section A and B of the form.
Physical checks are the only accepted form of verification: While attaching a voided check or deposit slip is recommended for direct debit authorization in Section D, this requirement mainly serves to verify the depositor account number and financial institution information. Other forms of account verification may be accepted if they provide the necessary account and routing numbers.
Limited to Missouri entities only: It might be misunderstood that only Missouri-based entities can use this form. However, any eligible individual or business, regardless of their state, can apply as long as they meet the requirements for lien filing or records access in Missouri.
Online access is immediate: Completing and submitting Form 5017 does not grant immediate online access. The application undergoes a review process by the Missouri Department of Revenue, which must approve the request before access is granted.
Application is for lien filing only: While the form prominently mentions the online notice of lien filing, it also allows for online records access, which includes motor vehicle and marine records, as clearly indicated in the transaction type requested section.
Application fees must be paid upfront: There's a misconception that an application fee is required when submitting Form 5017. The form does not specify any application fee, especially for access to online record services, which is mentioned as free in the instructions.
Direct Debit is mandatory: It may be believed that direct debit setup is mandatory for all transactions. Direct Debit is optional and only necessary if you want Notices of Liens processed or records accessed online to be debited directly from your account, as detailed in Section C and D.
Form does not cover record access: Another misconception could be that Form 5017 is solely for lien filing and does not cover record access. Section A clearly allows users to request online record access in addition to online notice of lien filing.
Security Access Code is not required: Some might think the Security Access Code (DPPA number) is optional. If requesting online records access, this code is necessary to comply with the federal Driver’s Privacy Protection Act, as indicated in Section B.
Electronic submission is available: While the form discusses online accounts, it might be misunderstood that Form 5017 can be submitted electronically. Submission details instruct the applicant to mail the completed form, indicating a physical submission process is required.
When individuals or businesses in Missouri need to manage online transactions related to vehicle liens and records with the Department of Revenue, the Form 5017 plays a crucial role. Here are seven key takeaways for filling out and using this important form:
Completing the Form 5017 accurately and understanding the commitments being made, especially in terms of direct debit authorizations, are essential for businesses and individuals engaging in lien filings and accessing vehicle or marine records in Missouri.
How to Make a Job Application - By signing the authorization for release of information, candidates facilitate a thorough background check by potential employers.
Contingent Allocation Meaning - Highlighting the necessity of designating beneficiaries correctly to avoid potential legal complications or disputes is underscored.