Form Tr-128 - Lienholder'S Consent To Transfer Ownership

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KANSAS

LIENHOLDER’S CONSENT

DEPARTMENT OF REVENUE

TO TRANSFER OWNERSHIP

DIVISION OF VEHICLES

WARNING: A

NY ALTERATIONS OR ERASURES WILL VOID THIS FORM

VEHICLE INFORMATION:

Please Type or Print Clearly

Vehicle

ID No.

Year

Make

Model

CURRENT OWNER INFORMATION

The owner(s) listed on the Kansas Certificate of Title:

Name(s)

Address

City

State

ZIP

LIEN HOLDER INFORMATION AND CONSENT

Lien Holder’s Name

Address

City

State

ZIP

The lien holder shown above has a lien recorded on a Kansas electronic title or a Kansas paper certificate of title issued in the name or names

shown above as current owner and hereby authorize the transfer or assignment of the vehicle listed on this consent with recording of their lien on

the new Kansas electronic title to be issued in the name or names shown as new owner listed below.

Authorized Lien Holder’s Signature

Date

Subscribed and sworn to before me on: Month

Day

Year

Notary Public Signature

SEAL

Commission Expires:

NOTE:

This

assignment can only be used to add an immediate family member (spouse, father,

mother, son and daughter), to remove a name or for name change due to marriage or court

order on a Kansas electronic or paperless title with at least one of the previous owners

remaining as an owner on the new Kansas title.

ANY OTHER TYPE OF ASSIGNMENT MUST BE

COMPLETED ON A KANSAS PAPER TITLE.

If Kansas has issued a paper title, this

assignment cannot be used.

By affixing his or her signature transferor assigns, transfers and conveys unto the new owner(s) the vehicle described on the Kansas Certificate of Title

and the lien holder listed on the Kansas Certificate of Title is listed hereon and consents to this assignment, transfer and conveyance. Kansas

residence must make application for title within 30 days of assignment in the county treasurer’s motor vehicle office where the vehicle will be garaged.

NEW OWNER INFORMATION:

Relationship of New Owner

Name(s)

Address

City

State

ZIP

I, the undersigned, hereby swear or affirm that I am the owner of the motor vehicle described herein and that the information provided in this title

assignment is true and correct to the best of my belief. I am aware that the law provides severe penalties for making false statements under oath.

This assignment and transfer was completed on:

Month

Day