KANSAS REQUEST FOR - Kansas Department of Revenue

[Pages:3]KANSAS

DEPARTMENT OF REVENUE DIVISION OF VEHICLE

VEHICLE INFORMATION

VIN: OWNER'S NAME(S) (Last, First, Middle Initial)

Name(s):

REQUEST FOR RELEASE OF LIEN

Year:

Make:

Model:

Style:

Address

LIEN HOLDER'S INFORMATION

Name:

City

State

ZIP

Account Number (If available):

Method of Payment Used:

Check Only ONE

Address

Cash Teller's Check

Wired funds Certified Check

Amount tendered as payment in full: $

City

Intra-bank Transfer ................
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