Form D-19 - Guarantee Of Compliance With The Vehicle Dealer And Manufacturers Licensing Act Certificate Of Deposit

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Kansas Department of Revenue
Division of Vehicle
For office use only
Dealer Licensing Bureau
Docking State Office Building
F#
Topeka, KS 66626-0001
Ph (785) 296-3621
Fax (785)296-5854
D#
Guarantee of Compliance with the
Vehicle Dealer and Manufacturers Licensing Act
Date Rec’d:
Certificate of Deposit
This agreement entered into this
day of
,
, between
, a bank organized under
Bank or Lending Institution
the laws of the United States or of the State of Kansas, hereinafter referred to as the “Bank”
and
, hereinafter referred to as the
Dealership Name
“Depositor”, is entered into to comply with the requirements of K. S. A. 8-2401 et seq.
The bank has issued a certificate of deposit in the amount of $30,000.00, issued jointly in the names of the State of Kansas and
Depositor. The Depositor may not assign, pledge as security for any loan or indebtedness or otherwise encumber the certificate during
the period of this agreement.
For the privilege of being licensed and selling motor vehicles in the State of Kansas, Depositor hereby grants the Kansas Department
of Revenue a security interest, for the benefit of any retail or wholesale buyer or seller of a vehicle who sustains any loss by reason of
any act by the Depositor in violation of any act which constitutes grounds for suspension or revocation of the Depositor’s motor
vehicle license, in the following described property:
, in the amount of $30,000.00, to be deposited with the Kansas State Treasurer.
Certificate of Deposit number
The Bank acknowledges receipt of notification of the Kansas Department of Revenue’s security interest in the above described
property.
When the Director of vehicles of the Kansas Department of Revenue determines that a certificate of deposit is no longer required for
the Depositor, notification in writing shall be made to the Kansas State Treasurer who will then be authorized to release the certificate
of deposit to the Depositor and thus terminate this agreement.
The Bank shall remit interest on the certificate of deposit to the Depositor.
RENEWAL DATE OF CD:
Dated at
, this
day of
,
.
Bank
Depositor (Dealership Name)
By:
Signature of authorized representative of bank
Signature of Depositor
(Owner or President of Dealership)
Bank Street Address
Depositor Street Address (Dealership Address)
City
State
Zip-Code
City
State
Zip-Code
(STATE OF
)
Subscribed and sworn to before me this
day of
(COUNTY OF
)
,
.
Month
Year
My Commission Expires:
Notary Public
D-19 (4-03)

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