PERSONALIZED PLATE APPLICATION
Department of Revenue
Take this completed form with a fee of $45.50
Division of Vehicles
PO Box 2505, Topeka, KS 66601-2505
to your County Treasurer’s Motor Vehicle Office
https://www.ksrevenue.org/
Owner’s Name
Address City State Zip
Dashes and Symbols cannot be used.
Combinations cannot be profane, vulgar, lewd or have an indecent meaning.
Vehicle must have a Kansas antique title to order an antique plate.
Interpretation or Meaning of Combination (REQUIRED)
Passenger or Truck Plate
Use Capital Letters
Personalized and Personalized Antique Plates
shall not contain more than 7 letters and/or
numbers.
Personalized Disabled Plates shall not contain
more than 5 letters and/or numbers.
Motorcycle Plate
Use Capital Letters
Personalized and Personalized Antique
Plates shall not contain more than 5
$45.50 Fee is for reservation of the personalized combination and DOES NOT INCLUDE annual
registration fee or one time antique registration fee.
I declare under penalty of perjury under the laws of the State of Kansas that the foregoing is true and correct. I
understand, and agree, once the personalized plate is manufactured there can be no refund of the fee listed
herein.
Owner’s Signature Printed Name Date
INSTRUCTIONS
1. Application for personalized license plates shall be made at your County Treasurer’s motor vehicle office.
2. Application must be signed by the applicant and include the appropriate fee. Make checks payable to the county
Treasurer for our county.
3. Application for disabled personalized plate(s) are required to submit a copy of applicants current Disabled ID
card or a completed Certification of Disability for Disabled Parking Placard &/or Plate, form TR-159, signed by
a healings arts professional.
TR-715PR (8/18)
click to sign
signature
click to edit
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