TITLE HELD BY
KANSAS
OUT-OF-STATE LIEN HOLDER
DEPARTMENT OF REVENUE
DIVISION OF VEHICLE
TOPEKA, KANSAS 66626-0001
County
Transaction ID#
Completed by County Treasurer’s Office
Owner Information
Owner(s) Name
KS
Address
City
State
ZIP
Vehicle Information
Year
Make
VIN
Title Issued by the State of
Lien Information
Name of Lien Holder
Account No:
Address
City
State
ZIP
Reason lien holder will not fax copy of title to county treasurer or inspection station:
Conditions
1. After receipt of the out-of-state title from the lien holder, the Division of Vehicles will send a
certified copy to the applicant, who will obtain a vehicle identification number inspection
through the local Kansas Highway Patrol and return the completed form (MVE-1), within 30
days, to the Kansas Department of Revenue, Titles and Registrations Bureau, Docking State
Office Building, 915 SW Harrison, Topeka, Kansas 66626-0001.
2. If the inspection is not received by the renewal date on the license plate, the tag will not be
renewed prior to completion of all requirements.
3. If the titling requirements are not completed in a timely manner, the Division of Vehicles
will return the title to the lien holder and issue a pick-up order for the license plate.
I, the undersigned, hereby certify that all the information on this form is true and correct and that
I have read the conditions set forth and agree to be bound by the same.
Owner’s Hand Printed Name
Owner’s Signature
Date
County Treasurer
TR-100www (3-07)