Fillable Form Tr-96s - Self-Service Storage - Lien Sale Affidavit printable pdf download

KANSAS

SELF-SERVICE STORAGE

DEPARTMENT OF REVENUE

DIVISION OF VEHICLES

IEN

ALE

FFIDAVIT

OMPLETE THE

NFORMATION THAT

ERTAINS TO THE

IEN BEING

LAIMED

VIN

Year

Make

Name of Occupant:

Vehicle

Approximate

License

State

License

Vehicle

Plate

Registered

Expiration

Information

Number

Date

Value

I, lien claimant, certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following

. Ø

statements is checked:

Excess mechanical limits

Not Actual - Warning: Odometer Discrepancy

Purchased

Vehicle

Name of

Date

Selling

Purchaser

Price

Information

Address

City

State

ZIP

Business/

Operator’s Name

Claimant’s

Business

Name

Address

City

State

ZIP

Information

Date Rent was Past Due

Date Late Fee Assessed

Date Vehicle Came into Possession/Control

Lien

Date of Lien Sale

Self-Storage Fee To Date

At the Rate of

Cost of Conducting Lien Sale

Information

Per

Day/

Month

Vehicle was Sold by:

Public Proceeding (Auction)

Private Proceeding

The date vehicle came into possession/control has no impact on KSA 58-818.

Sale of the property stored on the premises may be by public or private proceedings as long as the sale is commercially reasonable. KSA

58-817

and 84-9-627.

The following items must be A

to this affidavit (refer to details instruction of second page):

TTACHED

Verification of Ownership, and Lien Holder if applicable;

Copies of notices sent to occupant/owner and lien holder and proof that second notice was sent restricted mail to the

owner/occupant and by certified mail to the lien holder;

Copy of the newspaper ad; and

Copy of self storage/rental agreement.

An MVE-1 must be obtained by the person or business listed as purchaser above before going to the county treasurer’s motor

vehicle office to make application.

I, the undersigned, certify that the occupant/vehicle owner did enter into a self-storage rental agreement which resulted in the storage of the vehicle

listed herein and is in default of payment for said rent for more than 45 days. The vehicle was in the occupants/vehicle owner’s storage unit at the

time the operator prepared for sale. I am aware of and have complied with all requirements of the Self-Service Storage Act as defined in KSA

58-

813, including all additional statutes listed therein.

Further, I the undersigned, do hereby certify under penalty of perjury that, I am an operator of the self-service storage business located and doing

business in the State of Kansas at the address shown above. That the information contained on this affidavit is true and correct. I accept and take

all responsibility for to compliance with KSA 58-813 and statutes listed therein as well as requirements listed in this affidavit, and will be liable for any

harm resulting from failure to comply with self-service storage act.

Lien Claimant’s

Handprint

Signature

Name

Date

WARNING! KSA 21-3711 provides that FALSIFYING INFORMATION ON ANY REQUIRED DOCUMENT IS A SEVERITY LEVEL 8, NONPERSON

FELONY. KSA 21-3710 deals with forgery; forgery is knowingly and with intent to defraud and is a severity level 8 nonperson felony.

All documents indicated above in addition to this affidavit must be presented to the purchaser for the purpose of making application for title and

registration at the local county treasurer's motor vehicle office where purchaser resides. If vehicle fails to sale at public or private proceeding, the

claimant must apply for a title in business name. Application for title and registration must be made within 30 days from the “purchased

date” above.

NSTRUCTIONS AND

DDITIONAL

NFORMATION ON

ACK

TR-96S (Rev. 06/10)

Office: (785) 296-3621