Affidavit for Replacement or Non-Exchange



AFFIDAVIT FOR REPLACEMENT OR NON-EXCHANGEKRS 186A.990 states: Any person knowingly giving false information in connection with an application or title shall be guilty of forgery in the second degree.-114300952500 When making application for a duplicate title on a vehicle, please use TC 96-182, Application for Title or Registration. Affidavit for Replacement County: FORMTEXT ?????I CERTIFY THAT MY FORMCHECKBOX Certificate of Registration IS FORMCHECKBOX Lost FORMCHECKBOX Registration Plate FORMCHECKBOX County Change FORMCHECKBOX Decal FORMCHECKBOX Stolen FORMCHECKBOX Destroyed FORMCHECKBOX Rusted FORMCHECKBOX Other FORMTEXT ?????DescribeI hereby request a replacement for Registration Certificate, Registration Plate, or Decal # FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Owner(s) NameID (SSN or DL#)Owner(s) NameID (SSN or DL#) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ?????Street Address CityStateZipSignatureDateSignatureDate-476252476500Affidavit for Non-Exchange County: FORMTEXT ?????Title or Registration CTL # FORMTEXT ?????I CERTIFY BASED ON THE FORMCHECKBOX RepoOR REGISTRATION ACTION FORMCHECKBOX Plate ReplacementFOLLOWING TITLE ACTION: FORMCHECKBOX Junked Vehicle FORMCHECKBOX Vehicle Type Conversion FORMCHECKBOX Salvage Title FORMCHECKBOX Registration Conversion FORMCHECKBOX Title Only Transfer FORMCHECKBOX Registration Cancelthat the License Plate assigned to the motor vehicle or owner herein:VIN FORMTEXT ?????Plate FORMTEXT ?????and Decal FORMTEXT ?????described and currently registered in the Commonwealth of Kentucky does notaccompany the associated documents related to the aforementioned action because of the following non-exchangereason: FORMCHECKBOX Lost FORMCHECKBOX Special Plate FORMTEXT ????? FORMCHECKBOX Stolen FORMCHECKBOX Out of State FORMCHECKBOX Destroyed FORMCHECKBOX Other FORMTEXT ?????Describe FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Name of Company or DealershipID (SSN or DL#)Owner(s) NameID (SSN or DL#) FORMTEXT ????? FORMTEXT ?????Lending InstitutionStreet Address FORMTEXT ????? FORMTEXT ????? FORMTEXT ?? FORMTEXT ?????Street AddressCityStateZip FORMTEXT ????? FORMTEXT ?? FORMTEXT ?????CityStateZipSignature of Authorized RepresentativeOwner’s SignatureDateNotary for Replacement or Non-ExchangeSubscribed and attested before me on this date My commission #:MM DD YYYYMy commission expires:MM DD YYYYAttesting Official or Notary Signature and Title ................
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