Form D72 - Change Of Record Form
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2KANSAS DEPARTMENT OF REVENUE
DIVISION OF VEHICLES
F#_____________
DEALER LICENSING BUREAU
TOPEKA, KANSAS 66626-0001
71
PH # (785)296-3621
FAX (785)296-5854
CHANGE OF RECORD FORM
Please print or type legibly. Additional forms may be needed depending on the change.
D#
Dealer Name
Business or DBA Name Change
(requires Bond Rider, Insurance Certificate and Sales Tax Certificate with new name)
Business/Corporation Name
DBA
Phone/Fax/Email Change
(Your business phone must be in the business name and listed with the phone company)
Business Phone
Fax
Cell Phone
Email Address
Sales Tax ID/FEIN Change
(Copy of Kansas Sales Tax Certificate must be attached)
SALES TAX ID #:
FEIN:
Entity Type Change
(*Copy of Secretary of State’s Articles of Corporation required)
Individual (Sole Proprietor)
Partnership
Corporation*
Limited Liability Co.*
LTD Company*
Limited Liability Partnership*
Date Incorporated/Registered in Kansas
Other Corrections:
Owner’s Name
(Please Print)
X
Signature of Owner
Date
Signature
All Location Changes and application for Supplemental Locations must be completed on their (D12a); all Franchise
Certifications must be submitted on the (D100) with a copy of the Franchise Agreement. Insurance and Surety Bond
changes and updates must be submitted in their entirety on appropriate policy forms through their policy carriers.
SEE REVERSE SIDE TO ADD OWNERS
D72 (11/13)
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Parent category: Financial