KANSAS DEPARTMENT OF REVENUE
D#
DIVISION OF VEHICLES
DEALER LICENSING BUREAU
F#
TOPEKA, KANSAS 66626-0001
785-296-3621
License Fee
$
$
Adt'l Plate Fee @ 25.50 ea.
Total Fees Due
$
APPLICATION FOR OWNER TRANSFER
OF VEHICLE OR MFG’D HOME DEALER LICENSE
This transfer application for a Vehicle Dealer License will not be considered unless attached to an original application form D-17. The
applications must be completed in full, signed and returned with the appropriate fee, to the above address. Attention: Dealer Licensing.
TO BE COMPLETED BY THE SELLER:
We, holder of dealer license D-
hereby apply for ownership transfer of our license and plates to the below signed purchaser.
List all suffix letters of plates issued to your firm, including full-privilege plates.
If you have trailer or motorcycle plates, please also list the plate type. You may attach a separate sheet if
necessary.
FROM:
Current Dealer Business Name including dba
Street
City
County
State
Zip
TO:
New Business Name
Street
City
County
State
Zip
Selling Dealer Signature (Owner or Authorized Representative)
Print Name
By my signature I swear or affirm that this is a true and correct statement. I am aware that the law provides
severe penalties for making false statements under oath.
TO BE COMPLETED BY THE PURCHASER:
We, the undersigned, do hereby apply for the ownership transfer of dealer license D-
to our business name as indicated below:
New Business
Name (with dba):
New Business Phone
Business Address:
Street
City
County
State
Zip
Purchasing Dealer Signature (Owner or Authorized Representative)
Print Name
By my signature I swear or affirm that this is a true and correct statement. I am aware that the law provides
severe penalties for making false statements under oath.
NOTE:
Selling vehicle dealer may, upon payment of fifty percent (50%) of the annual licensing fee, have the vehicle dealer license and vehicle dealer
plates including all full privilege plates assigned to the purchasing dealer. In case of a partnership, all partners must sign the document where applicable.
Make checks or money orders payable to: The Director of Vehicles. Please notice the enclosed list of requirements and bond form. Your application will not
be considered without all requirements met and anapproved bond on file. Please do not mail in your transfer without the original application, fee and
necessary bond.
New & Used Vehicle Dealers:
We must have a current franchise agreement on file from each manufacturer listed on page two of the attached application.
Please contact the Dealer Licensing Bureau if you do not have this form.
D-23 (03-07)