Addition To Exemption Application Military Personnel Vehicles Form
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1Addition to Exemption
KSA 79-5107(e) or
50 App. U.S.C.A. § 571
Page 1 of 1
Applicant Name: _________________________
Docket No.: _____________________________
Addition to Exemption Application
Military Personnel Vehicles
K.S.A. 79-5107(e) or 50 App. U.S.C.A. § 571
1.
State your branch of military service. _______________________________________________
2.
Are you in full-time military service? _____No _____Yes
If yes, are you absent from this state solely by reason of military orders? _____No _____Yes
3.
Are you mobilized? _____No
_____Yes Date (mm/dd/yy) that you were mobilized:_______________________________
4.
Are you deployed? _____No
_____Yes Date (mm/dd/yy) you were deployed:___________________________________
5.
Your state of residence or domicile. _________________________________________________
Provide a copy of a driver’s license, voter registration card, or Leave and Earning Statement.
6.
Where are you stationed? _________________________________________________________
7.
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.)
8.
Where is/are the subject vehicle(s) maintained?________________________________________
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 7/14
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Parent category: Financial