Form Pub. Ks-1526 - Kansas Business Taxes For Motor Vehicle Transactions Page 34
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44KANSAS
A
F
FFIDAVIT TO A
ACT
DEPARTMENT OF REVENUE
DIVISION OF VEHICLES
Complete vehicle information, check and complete appropriate statement(s).
Must also
complete the Affiant’s Certification at the bottom of the form.
Please Type or Print Clearly
VEHICLE INFORMATION
Must be Completed
Year
Make
ID #
VEHICLE GIFT CERTIFICATION
(Used when vehicle or trailer is given as a gift and the recipient is not a relative.)
I, the undersigned, certify that I am the owner of the above referenced vehicle was presented as a gift to:
Owner’s
Handprinted Name:
ONE AND THE SAME PERSON
(Used when a person’s name changed or is incorrect. EX: Jim/James; Name Changed by Marriage)
I, the undersigned, certify that
and
are one and the same person.
DISCLAIMING VEHICLE OWNERSHIP
(Used when the purchaser shown on the title assignment is renouncing ownership.)
I, the undersigned, certify that I am disclaiming ownership as shown on the assignment of title for the above referenced
vehicle.
TITLE OR MSO ASSIGNMENT
(Used when adding a name(s) to the title assignment after the assignment was completed.)
We, the undersigned, certify the above referenced vehicle assignment was not properly completed at time of purchase.
Name of person to be added
on assignment as purchaser:
(All parties to be listed as purchasers must sign below.)
VEHICLE NON-USE
(Used when registering or renewing vehicle registration and the vehicle was not operated for a full registration year.
EX: A June expiration requires the vehicle to not be in operation from June of one year [sample 2001] until or after May of the following year [sample 2002])
I, the undersigned, certify that the above referenced vehicle was not
Beginning:
Month
Year
at any time operated during the registration year(s) shown to the right: Ending:
Month
Year
RELATIVES OF A MEMBER OF THE MILITARY (
Used when a family member is renewing the registration for a member of the
U.S. military. Person signing must follow the order listed. KSA 8-129)
I, the undersigned, certify that I am the (Must Check One):
Spouse;
Parent;
Eldest Brother or Sister
of
, a member of (branch of service)
.
ANTIQUE MODEL YEAR LICENSE PLATE (
Used when registering an antique vehicle with a model year Kansas license plate.)
License Plate Information
:
Year on Plate
Plate Number
All Letters and Numbers Must be Shown
I, the undersigned, certify that the license plate listed above is a legible and serviceable license plate, originally issued by the state of
Kansas and the expiration year inscribed thereon corresponds to the model year when the antique vehicle was manufactured.
A
’
C
FFIANT
S
ERTIFICATION
I certify under penalty of perjury that all information and statement(s) made above are true to the best of my knowledge.
Affiant’s Signature(s)
Printed Name of Person(s)
that Signed Above
Date
Previous versions of this form are subject to requirements listed herein.
TR-12www (Rev. 05/07)
Current form at: /pdf/forms/tr12.pdf
KS Division of Vehicles will make the final determination if the form is properly completed
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