Form Tr-164 - Oil Well Servicing, Clean-Out And Drilling Vehicle Registration Exemption Affidavit

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KANSAS
OIL WELL SERVICING, CLEAN-OUT AND
D
R
EPARTMENT OF
EVENUE
DRILLING VEHICLE
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
I certify this vehicle is
(M
C
A
L
O
):
USED EXCLUSIVELY FOR OIL WELL
UST
HECK
T
EAST
NE
Servicing
Cleaning-out
Drilling
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
Q
UALIFICATIONS
To qualify as exempt from registration the servicing rig, clean-out rig or drilling machinery
MUST BE USED
,
-
. The vehicle must have ALL of the
EXCLUSIVELY FOR SERVICING
CLEANING
OUT OR DRILLING OF OIL WELLS
following essentials to qualify for exemption:
A mast,
AND
An engine for power,
AND
Draw works,
AND
A chassis permanently constructed or assembled for one or more of those purposes.
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 oil well vehicles that were previously titled as nonhighway
NOT
will be titled with a Clear title upon the next application for title in Kansas.
KSA 8-126(ee), 8-128(c) and 8-177
Previous versions of this form are subject to requirements listed herein.
TR-164 www(Rev. 03/08)
KS Division of Vehicles will make the final determination if the form is properly completed.

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