Form Mcs-105 - Application For Refund Of Kansas Apportioned Fleet Registration
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1APPLICATION FOR REFUND OF KANSAS APPORTIONED FLEET REGISTRATION
This form is used to apply for refund of the balance of Kansas registration fees and/or THE CANCELATION
OF ANY REMAINING APPORTIONED FLEET QUARTERLY PAYMENT INSTALLMENTS FOR THE
following described apportioned vehicle(s) as provided in K.S.A. 8-1,116(c).
The KANSAS APPORTIONED REGISTRATION CAB CARD(s) and KANSAS APPORTIONED
LICENSE PLATE(S), and any supporting documents MUST BE RETURNED with this application.
Mail to:
Kansas Department of Revenue
SSN or FEIN
Motor Carrier Services Bureau
915 SW Harrison RM. 150
Topeka KS 656612
Apportioned Account Number
Phone: 785-296-6541
Registered Annually
NAME
Registered Quarterly
MAILING ADDRESS
Abate Fees
CITY AND STATE
ZIP
20___
YEAR
VEHICLE
*BASIS FOR
IF SOLD
DATE
PLATE
MADE
MAKE
IDENTIFICATION
REFUND OR
NAME OF PURCHASER
OF
NO.
NUMBER
CANCELLATION
AND ADDRESS
SALE
*BASIS FOR REFUND AND/OR CANCELLATION: Motor Vehicle has been SOLD, REPOSSESSED, JUNKED
FORECLOSED BY MECHANIC'S LIEN, OPERATION OF LAW, OWNER DECEASED. Indicate in this column the
reason a motor vehicle is no longer in your possession. See the reverse side of this form for required documents to be
filed with this application, and prerequisites to obtaining a refund or cancellation under proportional fleet registration.
The undersigned under oath swears and affirms that the above information is true and correct.
X
OWNERS SIGNATURE OR AUTHORIZED REPRESENTATIVE
TITLE
Date
OFFICE USE ONLY (Circle Applicable items)
Yes No
Need Tag(s):_____________________________
Yes No
All Plate(s) Returned
Yes No
All Cab Card(s) Returned
DATE RECEIVED:
Yes No
Copy of Bill of Sale attached
Yes No
Do Refund
Yes
No
Abate Quarter: 0901
0902
0903
Yes No
Do Denial Letter
(Circle all applicable)
MCS-105 (REV. 11/10)
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