Title or Position
with Agency
Handprinted Name
Of Person Above
Registration Year Issued by the State of License Plate No.
VIN Style Make Year
and Notice was Published on: (Dates)
Newspaper Published
and Printed In , KS
Name of Publication
Notice Was Printed In
Vehicle
Selling Price $
Date 15 Day Notice Mailed to
Registered Owner & Lienholder
Impoundment
Date
Purchaser’s
Name , of
of County , Kansas
Does this vehicle meet the definition of a salvage vehicle as per KSA 8-197(b)(2)(A or B)?
Yes* No
Staple
Attachments
Here
KANSAS
DEPARTMENT OF REVENUE
DIVISION OF VEHICLES
www.ksrevenue.org
ABANDONED VEHICLE AFFIDAVIT
(Public Agency Use Only)
Please Type or Print Clearly
Name of
Public Agency
Address City State ZIP
* If yes, a Salvage, Nonhighway or Nonrepairable Vehicle Affidavit, form TR-13, must be completed and attached by seller.
VEHICLE INFORMATION
I, the undersigned, certify that: I am authorized to act on behalf of the public agency shown on this affidavit. The vehicle shown on
this affidavit was left and abandoned within the jurisdiction of said public agency and was impounded on the date shown above.
Verification of Kansas title was requested from the Kansas Division of Vehicles
within . A 15 day notice was mailed by certified mail
2
to the lienholder(s) and registered owner on the date listed above indicating that if the removal and storage charges incurred were not
paid, the vehicle would be sold by the public agency at public auction to the highest bidder. Public agency used reasonable diligence
to determine the vehicle owner if vehicle was not registered in the State of Kansas. Notice was published once a week to two (2)
consecutive weeks in the newspaper shown in this affidavit
3
and is of general circulation in the county listed above. Notice described
the motor vehicle by make, year, model, VIN and name of owner, if known, stating that it had been impounded as an abandoned
vehicle by said public agency and would be sold at public auction to the highest bidder, if the owner does not claim the vehicle and pay
the removal, storage and publication costs incurred, at the time of sale. Pursuant to said notice, the owner or mortgagee did not claim
the motor vehicle and said motor vehicle was sold to the purchaser shown on this affidavit. I further certify that the information
contained on this affidavit is true and correct, that the supporting documentation listed on the bottom of this affidavit has been attached
and that all requirements and laws have been complied with.
Signature of Authorized Agent Date
P
urchaser must make application for title and registration in the local county treasurer's motor vehicle office in
the county in which the vehicle will be located within 30 days from date of purchase. Purchaser must submit all
documents received from the public agency to the county treasurer’s motor vehicle office when making
application for title and registration.
The seller (public agency) is to ensure the following are attached to this affidavit. Purchaser must take all these
documents to the county treasurer’s office when making application for title or title and registration.
1 Proof of verification of vehicle ownership record (verification must be applied for not more than 30 days after taking possession).
2 Proof of mailing of notice by certified mail to last registered owner and lienholder(s), if applicable.
3 Proof of publication of notice of public auction during two- (2) consecutive week period.
4
Odometer Disclosure Statement, form TR-59 must be attached if the vehicle is less than 10 years old, or beginning with model year
2011 vehicles, disclosure is required for 20 years.
TR-105www (Rev. 12/2020) (K.S.A. 8-1102 and K.S.A. 58-211)
