Form Tr-84a - Repossession Information Sheet printable pdf download

Form Tr-84a - Repossession Information Sheet

Mark Parkinson, Governor

Joan Wagnon, Secretary

________________________________________________________________

REPOSSESSION INFORMATION SHEET

Date Received

____________________

Title Service:

Customer/Owner Name

____________________

Vehicle ID# (Last six digits)

___________________

Do you want to be notified by e-mail when your titles are

completed?

Yes

E-mail address

_____________________

Telephone number in the event of problems/issues

______

How do you want to receive your titles?

Receive a call or email to come pick up the completed work,

Mailed by regular mail,

Delivered by Fed Ex or UPS?

Fed Ex or UPS Account #

__________________

Mailing Address:

City:

State:

Zip Code:

Person/Runner _____________________________________

Print Name

Person/Runner _____________________________________

Signature

Policy # 003 -2010 (revised 10/2010)

Repossession Title Processing

TR-84a

DIVISION OF VEHICLES

TITLES & REGISTRATIONS - REPOSSESSIONS

DOCKING STATE OFFICE BUILDING, 915 SW HARRISON ST., TOPEKA, KS 66612-1588

Voice 785-296-3621 Fax 785-296-3852

Form Tr-84a - Repossession Information Sheet