SALVAGE, NONHIGHWAY OR
NON-REPAIRABLE VEHICLE AFFIDAVIT
Kansas
DEPARTMENT OF REVENUE
DIVISION OF VEHICLES
www.ksrevenue.gov
T
HIS FORM MUST BE COMPLETED IN FULL
VEHICLE INFORMATION
Year Make Style VIN
¾ Select the appropriate designation and reason below.
SALVAGE VEHICLE (KSA 8-197: SALVAGE DEFINITIONS)
I, the undersigned, certify the following vehicle requires a salvage title for the following reason:
DAMAGED BY FLOOD
S
ALVAGE VEHICLE DUE TO VEHICLE BEING:
WRECKED OR DAMAGED
(
MUST CHECK ONLY ONE REASON LISTED.)
DAMAGED BY FIRE
NONHIGHWAY VEHICLE (KSA 8-197: NONHIGHWAY DEFINITIONS)
I, the undersigned, certify the following vehicle is qualified for a nonhighway title for the following reason:
(MUST CHECK ONLY ONE REASON LISTED BELOW.)
Due to discontinuing liability insurance coverage.
The following, but not limited to, are nonhighway vehicles due to not manufactured for street use: All-
Due to vehicle not
Terrain Vehicle (ATV); Work-Site Utility Vehicle; Micro Utility Truck, (Mini-Truck); Recreational Off-Road
manufactured for street use.
Vehicle (ROV); Off-Road Motorcycle (Dirt Bike).
NON-REPAIRABLE VEHICLE (KSA 8-135C: NONREPAIRABLE DEFINITION)
I, the undersigned, certify the following vehicle has been damaged, destroyed, wrecked, burned or submerged in water to the extent
that such motor vehicle is incapable of safe operation for use on roads or highways and has no resale value except as a source of
parts or scrap only; or that as owner, I irreversibly designate this vehicle as a source of parts or scrap.
BOTH boxes MUST be checked when designating a vehicle as nonrepairable.
I irreversible designate this vehicle as nonrepairable (IRREVERSIBLE MEANS THE NONREPAIRABLE CERTIFICATE
CANNOT BE REVERSED OR REMOVED). KSA 8-135c
I understand by designating this vehicle as nonrepairable, the vehicle can NEVER be registered or retitled for use on
the road or highways in any state or sold as a unit (complete vehicle) to anyone other than a recycler.
By signing this affidavit, I hereby certify the vehicle described above will not be operated on the streets or highways of this state until financial security (liability
insurance) is obtained
AND a roadworthy title (Rebuilt Salvage or Formerly Non-Highway title) is applied for and license plate has been issued. I further certify that to
the best of my knowledge the reason for the salvage or nonhighway or non-repairable status is true and correct.
Signature of Owner Date
Hand Printed Name of Person Signing Above
NOTICE
9 This affidavit must be attached to the certificate of title before making application for a salvage, non-highway, or non-repairable title. KSA 8-198(b)(2)
9 This affidavit is required when applying for a salvage, non-highway or non-repairable title using a non-branded title or if applying for a salvage or non-repairable
title using a nonhighway or formerly nonhighway title. Also required if going from salvage or rebuilt salvage to nonrepairable.
9 Seller or owner transferring a salvage or nonhighway vehicle on a regular properly assigned and/or reassigned Kansas Certificate of Title should retain a copy of
this affidavit in their files. Buyer must make application for the appropriate title within 30 days of assignment of the title.
9 Claimants retaining possession of a vehicle that has been declared as non-repairable by an insurer will have 30 days from the date of notification by the insurer
to apply for a non-repairable vehicle certificate. Insurers are required to notify the Division of Vehicles when a vehicle is declared as non-repairable. The
Division of Vehicles will record the vehicle as non-repairable. Only the application for the non-repairable vehicle certificate will be accepted thereafter.
¾ Once a vehicle has been designated as salvage, nonhighway or non-repairable it will forever be branded as such. Only a salvage and nonhighway
vehicle may be repaired and/or restored to roadworthy condition and be retitled as rebuilt salvage or formerly nonhighway.
TR-13 (Rev. 03/12)
