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Reset Form Form 5423 Print Form Missouri Department of Revenue Bill of Sale For Scrap Metal Operators – Vehicles Ten Years or Older Without Title Business Information This bill of sale is to be completed under Section 301.227, RSMo, by a scrap metal operator who acquires 1) a motor vehicle that is inoperable and at least ten years old or 2) parts from a motor vehicle that is inoperable and at least ten years old without obtaining the certificate of title.. Name of Person Delivering Vehicle Driver License Number State Issuing Driver License Scrap Metal Operator’s Certification of Facts If seller is an insurance company or an agent for an insurance company, complete the following: Name of Insurance Company Loss Claim Number NAIC Number I certify the following under penalties of perjury: • The vehicle identified on this bill of sale was acquired from the seller named above • The vehicle identified on this bill of sale is inoperable due to the vehicle being in a rusted, wrecked, discarded, worn out, extensively damaged, dismantled, and mechanically inoperative condition and • If the vehicle is fewer than 20 years old, I have accessed the Department of Revenue’s online record access system and have determined that the vehicle identified on this bill of sale is not subject to any recorded security interest or lien..
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