Form 5017-2025

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The document is an application form (Form 5017) from the Missouri Department of Revenue's Motor Vehicle Bureau for individuals or businesses to create or modify an online account for filing Notices of Lien, accessing motor vehicle records, and setting up direct debit payments. It includes sections for applicant information, transaction types, financial institution details, and direct debit authorization.

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Click ‘Get Form’ to open it in the editor.
In Section A, select the appropriate application type by checking 'New', 'Change', or 'Cancel'. Then, indicate the transaction types requested by checking the relevant boxes.
Proceed to Section B and fill in all required fields for both the business and contact person. Ensure you include the identification number and security access code if applicable.
If you are applying for a new account or changing information, complete Section C with your financial institution's details, including name, address, and account type.
In Section D, authorize direct debit by checking the appropriate box and attaching a voided check or deposit slip. Sign and print your name as required.

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