KANSAS TITLE AND REGISTRATION
KANSAS
Department of Revenue Division of Vehicles
PO Box 2505, Topeka, KS 66601-2505
TITLE AND REGISTRATION MANUAL APPLICATION
Clear Form
County Name
Plate Type
Owner's Name(s) (Last, First, Middle Initial)
Application Date DL, FEIN, TIN, SSN (provide one)
Address VIN Purchase/Brought into KS Date Empty Weight
City Year Mileage Declared/Gross Weight
Make
State
Zip
Model
Actual ExceedsNot ActualExempt
Truck Class
Title Mailing Address
Name
Address
City
License Plate/ Registration Mailing Address
Name
Push Notification Phone or Email
Address
City
1st Lienholder Mailing Address
Name
Address
City
2nd Lienholder Mailing Address (Trk/Mbl Home only)
Name
Address
City
Transfer on Death
1st TOD Name
Address
City
2nd TOD Name
Address
City
State
Zip
State
Zip
State
Zip
State
Zip
State
Zip
State
Zip
Plate Transfer Information Previous Vehicle's VIN Vehicle Sold to/Repossessed by Adding Name to Title/Registration Relationship Spouse
Parent
Year
Child
Signature of Person Being Added
Insurance Co. Name
Insurance Policy No.
I hereby certify that I am a resident or have a bona fide place of business in this county and that I am an owner of and have in effect financial security for the aforementioned vehicle as required by Kansas Law. I further certify that all liens and/or encumbrances, if any, are listed and the information on this application is true and correct to the best of my knowledge. FALSE CERTIFICATION CAN RESULT IN CRIMINAL PROSECUTION Owner's Signature(s)
Date
Make
Model
Fee Summary
Title Fee Title Penalty
Registration Fee Registration Penalty
DMV Modernization Fee County Service Fee Law Enforcement Training Center Fee Reflectorized Plate Fee Property/Tax Due
Property/Tax Penalty Previous Property/RV Tax Due
Previous Property/RV Tax Penalty KHP Staffing and Training Fee Miscellaneous Fee Sales Tax
GRAND TOTAL
TR-212a (8/18)
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