MISSOURI STATE HIGHWAY PATROL SHP-466D 10/07 RETURN OF ...

MISSOURI STATE HIGHWAY PATROL

RETURN OF EXPIRED STICKERS / DECALS

SHP-466D 10/07

This form is used for EXCHANGES only.

(Submission of this form is valid ONLY between January 1 & April 30)

Use SHP-455 to REQUISITION stickers / decals / authorities.

Date

Station Name

Mail to: Missouri State Highway Patrol Motor Vehicle Inspection Division P.O. Box 568 Jefferson City, MO 65102

Station Number

Street Address

County

City

Zip

Authorized Signature

Return of safety inspection stickers # Total # of stickers being exchanged =

SAFETY INSPECTION STICKERS

through

through

@ $1.50 = $

Return of motorcycle decals # Total # of decals being exchanged =

MOTORCYCLE DECALS

through through

@ $1.50 = $

TOTAL CREDIT DUE FOR THIS EXCHANGE =

$

Exchange is requested as follows:

Inspection Stickers @ $1.50 =

$

Motorcycle Decals @ $1.50 =

$

Safety Inspection Authorities @ $1.50 = $

Credit (Line A)

Credit (Line B) Add Lines A & B

Cost (Line C) Cost (Line D) Cost (Line E)

Assignment of Safety Inspection Authorities: Authorities to Analyzer # Authorities to Analyzer #

TOTAL COST VALUE FOR THIS EXCHANGE =

$

Add Lines C - E (above)

********NOTICE: "Total Credit Due for this Exchange" must equal "Total Cost Value For This Exchange" in order for a request to be processed. Failure by the station to balance these two amounts prior to sending in this request will result in a return of this request to the station.

FOR MISSOURI STATE HIGHWAY PATROL USE ONLY

Safety Inspection Stickers Motorcycle Decals Safety Inspection Authorities

through through through

The above-referenced exchanges were processed by the Motor Vehicle Inspection Division on:

GHQ Processor Initials

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