Form Tr-163 - Hydraulic Concrete Pumper Truck Registration Exemption Affidavit
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1KANSAS
HYDRAULIC CONCRETE PUMPER TRUCK
D
R
EPARTMENT OF
EVENUE
D
V
IVISION OF
EHICLES
REGISTRATION EXEMPTION AFFIDAVIT
.
.
WWW
KSREVENUE
ORG
Please Type or Print Legible
V
I
EHICLE
NFORMATION
Year
Make
Vehicle ID Number
O
I
WNER
NFORMATION
Vehicle Owned By:
Address
City
State
ZIP
C
ERTIFICATION
By my signature below I certify this vehicle is a truck permanently mounted with a hydraulic concrete
pump and placing boom which is moved on the highways of this state from one job location to another,
or to or from places of storage delivery or repair. This vehicle is not a ready-mix concrete truck.
I, the undersigned, swear or affirm the vehicle referenced above meets all the qualifications listed herein
and that this is a true and correct affidavit. I am aware that the law provides severe penalties for making
a false statement under oath. In addition, I am aware that any person swearing falsely to any affidavit
shall be deemed guilty of a misdemeanor and upon conviction thereof shall be punished by a fine not to
exceed five hundred dollars ($500).
Owner’s Signature
Hand Printed Name of Person Signing Above
Date
This completed form and the title for the vehicle must be submitted to the County Treasurer’s Motor Vehicle
office to make application for a T
O
. Vehicles meeting the qualification listed above are exemption from
ITLE
NLY
registration and are
nonhighway vehicles. Any
NOT
truck permanently mounted with a hydraulic concrete
that were previously titled as nonhighway will be titled with a Clear title upon the next
pump and placing boom
application for title in Kansas.
KSA 8-128(d) and 8-177
Previous versions of this form are subject to requirements listed herein.
TR-163www (04/08)
KS Division of Vehicles will make the final determination if the form is properly completed.
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