Possessory Lien Affidavit (Wrecker And/or Towing Service) - Kansas Department Of Revenue, Division Of Vehicles
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1
2KANSAS
POSSESSORY LIEN AFFIDAVIT
DEPARTMENT OF REVENUE
(Wrecker and/or Towing Service)
DIVISION OF VEHICLES
KSA 8-1103 through 8-1108
T
MUST
C
’
E
Please Type or Print Clearly
HIS FORM
BE
OMPLETED IN IT
S
NTIRETY
Tow Service Name
KCC MCID No.
Address
City
ST
ZIP
Purchaser’s Name
, at
Address
City
ST
ZIP
TOW REQUESTED/AUTHORIZED BY
Driver
Law Enforcement
(Must Check One):
VEHICLE INFORMATION
Year
Make
Style
VIN
Possessory Date
Total Tow & Storage
Total Expenses of
(Date Towed)
Bill Accumulated:
$
Publication and Sale $
Date of the Public Auction
Vehicle Selling Price
$
Yes*
No
Does this vehicle meet the definition of a salvage vehicle as per KSA 8-197(b)(2)(A or B)?
*
If yes, a Salvage, Nonhighway or Nonrepairable Vehicle Affidavit, form TR-13, must be completed and attached by seller.
Definition of a salvage vehicle is on the backside of this form.
I
:
F THE VEHICLE OWNER IS KNOWN
Within 15 days of providing the tow service a notice shall be given to the owner
that the vehicle is being held subject to satisfaction of the lien.
Vehicle remaining in the possession of a person providing wrecker or tow service for a period of 30 days after such
wrecker or towing service was provided may be sold pay the reasonable or agreed charges for such recovery,
transportation, protection, storage or safekeeping of such vehicle and personal property (KSA 8-1103).
T
KSA 8-1104
:
HE FOLLOWING REQUIREMENTS OF
ARE NEEDED TO DISPOSE OF THIS VEHICLE
A. Not more than 30 days after taking possession of the vehicle, apply for a verification of last registered owner and
lienholder(s), if any, from the Division of Vehicles;
B. Notice of sale shall be mailed by certified mail to the registered owner and any lienholder(s) within 10 days after receipt
of the verification of the last owner and lienholder(s), if any, from the division of vehicles. The notice shall state that if
the amount due, together with storage, publication, notice and sale cost, is not paid within 15 days from the date of the
mailing, the vehicle and personal property will be sold at public auction;
C. A notice must be published in a newspaper in the County or City where the sale (public auction) is advertised to take
place. The vehicle make, year, and complete identification number as well as the date, time and place of the sale shall be
included in the advertisement. Should there be no newspaper published in the county, notice shall be published in a
newspaper of general circulation.
I, the undersigned, hereby certify that I am a towing and recovery service as defined by Kansas law, located and doing business in the state
of Kansas at the address shown above. The vehicle listed on this affidavit has remained in my possession since the possessory date shown
to the present time. Towing and recovery charges and the storage bill have accumulated on the vehicle and remain unpaid. Therefore, I
claim a lien on said vehicle based on the charges listed in this affidavit. Notice was given that the vehicle was to be sold at public auction
on the date listed.
I certify under penalty of perjury under the laws of the State of Kansas that the forgoing if true and correct.
Executed on (date):
Possessory Lienholder’s Signature
Handprinted Name of Person Signing Above:
Purchaser must make application for title and registration in the local county treasurer's motor vehicle office in the county in
which the vehicle will be located within 30 days from date of purchase. Purchaser must submit all documents received from the
tow service to the county treasurer’s motor vehicle office when making application for title and registration.
TR-85 www(Rev. 06/04)
See Next Page for Additional Requirements
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