Addition To Exemption Application Vehicles Form

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Addition to Exemption
Vehicles
Page 1 of 1
Applicant Name: _______________________
Docket No.: ___________________________
Addition to Exemption Application
Vehicles
1.
Provide a copy of the title(s) to the subject vehicle(s).
(Note: Effective January 1, 2003, titles for vehicles subject to liens or security interests are held in
electronic format by the Kansas Department of Revenue, Division of Vehicles. If this affects your
vehicle and you cannot provide a copy of a paper title, please provide a copy of another document
showing the date you acquired the subject vehicle, such as your first registration receipt showing a
“Purch/To KS” date or a dated bill of sale.)
2.
Where is/are the vehicle(s) housed when not in use?
______________________________________________________________________________
3.
If the vehicle(s) is/are kept at an individual’s home, please explain why.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4.
What percentage of the time is/are the vehicle(s) used for personal use?_____________________
5.
Do the operators of the vehicle(s) own personal vehicles that they drive to and from work?
_____Yes
_____No
6.
Is/are the vehicle(s) considered in any way to be compensation for salary?
_____Yes
_____No
VERIFICATION
I, ________________________________, do solemnly swear or affirm that the information set forth
herein is true and correct, to the best of my knowledge and belief. So help me God.
_______________________________________
Signature of Applicant
State of ______________________
County of ____________________
This instrument was acknowledged before me on _________ by ________________________________.
Seal
______________________________________
Signature of Notary Public
My appointment expires: ________________
Revised 5/07

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