KANSAS
DEPARTMENT OF REVENUE
DIVISION OF VEHICLES
www.ksrevenue.org
LIENHOLDER’S CONSENT
TO TRANSFER OWNERSHIP
WARNING: ANY ALTERATIONS OR ERASURES WILL VOID THIS FORM.
VEHICLE INFORMATION: Please Type or Print Clearly
Vehicle
ID No. Year
Make Model
CURRENT OWNER INFORMATION The owner(s) listed on the Kansas Certificate of Title:
Name(s)
Address City State ZIP
LIEN HOLDER INFORMATION AND CONSENT
Lien Holder’s Name
Address City State ZIP
The lien holder shown above has a lien recorded on a Kansas electronic title or a Kansas paper certificate of title issued in the name or names
shown above as current owner and hereby authorize the transfer or assignment of the vehicle listed on this consent with recording of their lien on
the new Kansas electronic title to be issued in the name or names shown as new owner listed below.
Authorized Lien Holder’s Signature Date
Subscribed and sworn to before me on: Month Day Year
Notary Public Signature SEAL
Commission Expires:
NOTE: This assignment can only be used to add an immediate family member (spouse, father,
mother, son and daughter), to remove a name or for name change due to marriage or court
order on a Kansas electronic or paperless title with at least one of the previous owners
remaining as an owner on the new Kansas title. ANY OTHER TYPE OF ASSIGNMENT MUST BE
COMPLETED ON A KANSAS PAPER TITLE. If Kansas has issued a paper title, this
assignment cannot be used.
By affixing his or her signature transferor assigns, transfers and conveys unto the new owner(s) the vehicle described on the Kansas Certificate of Title
and the lien holder listed on the Kansas Certificate of Title is listed hereon and consents to this assignment, transfer and conveyance. Kansas
residence must make application for title within 30 days of assignment in the county treasurer’s motor vehicle office where the vehicle will be garaged.
NEW OWNER INFORMATION: Relationship of New Owner:
Name(s)
Address City State ZIP
I, the undersigned, hereby swear or affirm that I am the owner of the motor vehicle described herein and that the information provided in this title
assignment is true and correct to the best of my belief. I am aware that the law provides severe penalties for making false statements under oath.
This assignment and transfer was completed on: Month Day Year
Owner’s Owner’s Hand
Signature Printed Name
I, new owner, am aware that my name is being added to the title of this vehicle.
(Person(s) being added as new owner(s) must sign.)
New Owner’s
Signature
TR-128 www(05/03)
