Kansas Department of Revenue
Division of Vehicles
PO Box 2505
Topeka, KS 66601
https://www.ksrevenue.org
TITLE AND REGISTRATION
MANUAL APPLICATION
New Owner’s Name(s): ______________________________ ______________________________
______________________________ ______________________________
AND OR
Owner Distinction:
If "AND" is selected, signatures of all registered owners will be required
Address: _________________________________________________________________________
City: _______________________ State:_________ Zip: ____________ Phone: ________________
VIN: _____________________________________ Year: ___________ Make: _________________
Model: _____________________ Mileage: _____________ Purchase Date: ____________________
Vehicle Color: _______________ Trim Level: ___________ Fuel Type: Gasoline Diesel Hybrid
Other: ___________________
Lienholder Information (If Applicable)
Lienholder Name: _________________________________________________________________
Lienholder Address: _______________________________________________________________
Transfer on Death Designees (Optional)- If more than 1, please supply listed information on additional sheet.
Name, Address, Date of Birth: _______________________________________________________
Title/Registration Mailing (If Different From Above)
Address: _________________________________________________________________________
Kansas State Parks Passport
Please check here if you would like to add this to your registration: $15.50
Plate Transfer Information (If Applicable)
Previous Vehicle VIN ______________________________ Previous Vehicle Plate ____________
I hereby certify that I am a resident or have a bona fide place of business in this county and that I am an owner of and have in effect financial
security for the aforementioned vehicle as required by Kansas Law. I further certify that all liens and/or encumbrances, if any, are listed and the
information on this application is true and correct to the best of my knowledge. FALSE CERTIFICATION CAN RESULT IN CRIMINAL
PROSECUTION
Owner’s Signature(s): ______________________________ ______________________________
______________________________ Date: _________________________
Did you check the “Helpful Hints?” Please check the list before submitting your paperwork. Questions? E-mail us at dmv@jocogov.org.
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