MOTOR VEHICLE INSPECTION STATION APPLICATION
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MISSOURI STATE HIGHWAY PATROL
SHP-450S 04/21
MOTOR VEHICLE INSPECTION STATION APPLICATION PDF INSTRUCTIONS
BUSINESS NAME OR GOVERNMENTAL UNIT PHYSICAL / SHIPPING ADDRESS
SAFETY COUNTY
STATION PERMIT NUMBER EMISSIONS
TROOP
CITY
ZIP CODE
AREA CODE & TELEPHONE NUMBER
MAILING ADDRESS (IF DIFFERENT THAN ABOVE)
ZIP CODE
BUSINESS E-MAIL ADDRESS
BUSINESS STRUCTURE
SP -- SOLE PROPRIETORSHIP
PT -- PARTNERSHIP
LIST EACH BUSINESS OWNER(S), CORPORATE OFFICERS, OR GOVERNMENT OFFICIAL TITLE
LLC -- LIMITED LIABILITY CORPORATION
CR -- CORPORATION TITLE
TITLE
TITLE
SUBSIDIARY BUSINESSES OR UNITS (LIST SUBSIDIARIES WHOSE VEHICLES WILL BE INSPECTED UNDER A WRITTEN MAINTENANCE AGREEMENT.)
PERSON AT STATION IN CHARGE OF INSPECTIONS
DAYS & HOURS WHEN INSPECTIONS WILL BE MADE (FILL IN THE NORMAL STARTING & STOPPING TIME FOR EACH INSPECTION DAY.)
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
TO
TO
TO
TO
TO
INSPECTOR MECHANIC PERSONNEL (LIST ONLY ACTIVE MECHANICS THAT HAVE A VALID INSPECTOR MECHANIC PERMIT.)
LAST NAME
PERMIT NUMBER
LAST NAME
01
02
FRIDAY TO
SATURDAY TO
PERMIT NUMBER
03
04
05
06
07 FACILITIES & EQUIPMENT FACILITIES
08 EMISSIONS ANALYZER NUMBER
NUMBER OF INSIDE LANES APPROVED
SY
SY
APPROVED OUTSIDE AREA
YES
NO
SY
CERTIFICATION OF OWNER, MANAGER OR GOVERNMENT DIRECTOR
I CERTIFY THAT ALL INFORMATION IN THIS APPLICATION IS ACCURATE AND COMPLETE.
TYPE OR PRINT NAME
SIGNATURE ACTION RECOMMENDED ON APPLICATION BY MSHP
APPROVED
NEW
RENEW
REINSTATE
TRANSFER
CLASS OF STATION APPROVED
A
B
C
D
G
INSPECTION STATION APPROVED BY:
PRINTED NAME
TITLE OR POSITION
DATE
TYPE OF STATION APPROVED
ENDORSEMENTS (PUBLIC CLASS B STATIONS ONLY)
CMV
MC / AC
SIGNATURE
PUBLIC
PRIVATE
GOVERNMENTAL
STATION ASSIGNED TO BADGE NO.
BADGE
DATE
MAIL ALL PAPERWORK AND MONIES TO:
MAKE PAYABLE TO "DIRECTOR OF REVENUE" CHECK
MISSOURI STATE HIGHWAY PATROL MOTOR VEHICLE INSPECTION 1510 EAST ELM, P.O. BOX 568 JEFFERSON CITY, MO 65102-0568
MONEY ORDER
DATE
SAFETY PERMIT -- $10.00
EMISSIONS PERMIT -- $100.00
MVI USE ONLY DATE PROCESSED
CLERK APPROVING
OVERNIGHT ADDRESS:
MISSOURI STATE HIGHWAY PATROL MOTOR VEHICLE INSPECTION 1510 EAST ELM JEFFERSON CITY, MO 65101
AMOUNT
PERMIT EXPIRED DATE
REMARKS ON BACK
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